Endoscopic 3-S Technique Tympanoplasty: Taking the Convention a Step Ahead

Abstract

Introduction
 Endoscopic Surgery has immense potential for middle ear surgery and is currently favoured by many surgeons. The 3 (vascular) Strips/ 3 Flap Tympanoplasty with operating microscope is popular but Endoscopic 3-Flap Tympanoplasty remains less explored. Hence this study was conducted to compare advantages and disadvantages of Endoscopic and Microscopic 3-Flap Tympanoplasty.
 Materials and Methods
 Forty two patients with large/subtotal perforation of tympanic membrane were divided into two equal groups (Group A & B). Endoscope was used in Group A, whereas, operating microscope in Group B. Temporalis fascia was the graft material in all patients. Patients were followed up for six months. Pre and post-operative audiograms, post-operative pain, graft uptake, time taken for surgery and intra-operative visualization convenience were compared.
 Results
 Mean Air-Bone Gap closure at the end of six months was 9.23 dB (SD-0.88 dB) in the endoscope group and 8.95 dB (SD-0.66 dB) in microscope group whereas the graft uptake rate was 95.2% and 90.2% respectively. Post-operative pain, cosmesis, ease of doing surgery and time taken for surgery were better in ‘Endoscope’ as compared to ‘Microscope’ group.
 Conclusion
 The three flaps produce adequate exposure in very large or subtotal perforations, very thin anterior rim or with anterior bony overhang. Results in terms of mean hearing gain and graft uptake were comparable. In terms of morbidity (post-op pain), recovery (return to routine activity), mean duration of surgery and cosmesis, endoscopic surgery produced better outcome.