Comparative Study of Endoscope Assisted Myringoplasty and Microscopic Myringoplasty

Abstract

To study and compare the outcomes of the endoscopic versus microscopic approach to Myringoplasty in 60 patients. In this prospective study, the outcomes of 60 ears of 60 patients (40 male and 20 female) who underwent Myringoplasty were evaluated. The age range of the patients was 15-55 years. Group 1 underwent Myringoplasty with an endoscopic technique (n = 30), and Group 2 underwent Myringoplasty with the conventional microscopic technique (n = 30). A temporalis fascia graft was used in both groups. The outcomes were analyzed in terms of the hearing gain, duration of surgery, graft success rate and advantages and disadvantages of endoscopic versus microscopic approach to Myringoplasty. In both groups, the postoperative air-bone gap (ABG) was significantly lower than the preoperative ABG. There were no significant differences between the preoperative and postoperative ABG values (in dB) in either group. The mean operative duration in Group 1 (96.32 min) was significantly lower than that in Group 2 (136.09 min). In the preoperative evaluation of patients in Group 1 had small, medium, large perforations are 16 (53 %), 12 (40 %), and 02 (7 %), respectively. In Group 2, had small, medium, large perforations are 12 (40 %), 15 (50 %), and 03 (10 %), respectively. Perforations (wet ear) were detected in 10 (33 %), 06 (20 %), and 04 (12 %) of the patients in Group 1 at postoperative months 1, 3, and 6, respectively. Perforations (wet ear) were detected 09 (30 %), 06 (20 %) and 03 (10 %) patients in Group 2 at postoperative months 1, 3, and 6. At 6 months postoperatively, there were smaller perforations and reduced rate of perforations as compared to 1st and 3rd month in Group 1 and Group 2. The difference between the perforation conditions (larger vs. smaller) was not significant in either group. The preoperative and postoperative increases in the ABG were associated. At the end of 6 months all (100 %) patients in the Group 1 rated their cosmetic result as excellent as compared in the Group 2. Unlike the microscope, the endoscope is easily transportable and hence is ideal for use in ear surgery camps conducted in remote places. In patients undergoing Myringoplasty, especially if the external ear canal is narrow and the anterior canal wall is prominent, the endoscopic and microscopic approaches appear to give equal results in terms of easy visualization of the entire tympanic membrane and no requirement for extra intervention to evaluate the ossicular system. A shorter operative duration and excellent cosmetic result is an advantage of the endoscopic Myringoplasty technique.

Endoscopic type I tympanoplasty is as effective as microscopic type I tympanoplasty but less invasive—A meta‐analysis

“…Our primary search yielded a total of 8700 records. In the screening of the records by title, abstract and full‐text, we found 18 articles which met the eligibility criteria . We found two publications with identical cohorts of patients; therefore, we excluded the recently published one .…”

“…Sixteen studies including 1179 interventions were deemed eligible for inclusion . Accrued results, in which endoscopic type I tympanoplasty was as effective as microscopic type I tympanoplasty in a homogenous dataset, indicated a 90.5% graft uptake rate in the endoscopic and 88.3% success rate in the microscopic group (OR: 1.21, CI: 0.82‐1.77; I 2 = 0.0%, P = 0.910) (Figure ).…”

A Comparative Study to Compare the Outcomes of Myringoplasty (Endoscopic Versus Microscopic)

“…Lakpathi G et al in their study, found that (100 %) patients in the endoscope group rated their cosmetic result as excellent, where as in the microscope group 06 (20 %) patients rated their cosmetic result as poor, 15 (50 %) rated the cosmetic result as satisfactory and 9 (30 %) patients rated their cosmetic result as excellent. [3] Their findings were echoed by Harugop AS et al in their study, they observed that at the end of six months all (100%) patients in the endoscope group rated their cosmetic result as excellent whereas in the microscope group 10 (20%) patients rated their cosmetic result as poor, 25 (50%) patients rated the cosmetic result as satisfactory and 15(30%) patients rated their cosmetic result as excellent. [2] In the study conducted by Kumar M, et al, in the endoscopy group all the patients rated their cosmetic outcome as excellent, whereas in the microscopic group 10 patients (33.3%) rated their cosmetic result as excellent, 16(53.3%) and 4(13.3%) patients rated their cosmesis as satisfactory and poor respectively.…”

“…[2] Similarly in the study conducted by Lakpathi G. et al, they found at 6 months, 26 (88 %) patients had a successful outcome in the endoscope group and 27(90 %) patients had a successful outcome in microscope group. [3] In the study conducted by Kumar M. et al, graft uptake was 86% in the conventional microscopic group and 83% in the endoscopic group. [4] Shoeb M. et al found the drum healing or graft uptake was 93.33% in both the groups (microscopic and endoscopic groups).…”

“…In the microscopic group AB gap closure within 20 dB was seen in 28 of 30 patients (93.3%) and in the endoscopic group closure of AB gap within 20 dB was seen in 27 of 30 patients (90%).In the study conducted by Lakpathi G. et al almost 90 % of patients post operatively had an improvement in conductive hearing loss with average between 0 and 20 dB conductive hearing loss in both the microscopic as well as endoscopic groups. [3] Harugop AS et al in their study found that almost all the patients in both the endoscopic as well as microscopic groups had a postoperative hearing threshold within 30 dB. [6] In the study conducted by Shoeb M. et al found that in the microscopic and endoscopic groups the preoperative mean AB gap was 38.87±4.88 dB and 35.6±6.31 respectively and post-operative at 6months mean AB gap was 17.47±1.96 dB and 16.8±74.32 dB respectively.…”