Endoscopic Lateral Cartilage Graft Tympanoplasty

Abstract

Objective To describe a novel technique for lateral graft tympanoplasty. Study Design Case series with chart review. Setting Tertiary care university hospital. Subjects and Methods Pediatric and adult patients with tympanic membrane perforations deemed unfavorable for a medial graft technique due to the perforation characteristics or myringitis. Results Between 2014 and 2016, 34 ears from 31 patients underwent a transcanal endoscopic lateral cartilage graft tympanoplasty. The mean age was 24.4 years (range, 6-71 years), and 22 patients (65%) were younger than 18 years. All patients had tympanic membrane perforations. Eighteen patients (53%) had total or near-total perforations, leaving a minimal anterior remnant, and 16 patients (47%) had extensive myringitis. A bisected tragal cartilage-perichondrium shield graft was used in 33 patients (97%). The mean (SD) follow-up length was 9.8 (5.7) months. Initial perforation closure rate was 88.2% (30/34). Three of the persistent perforations underwent a revision endoscopic medial graft tympanoplasty with successful closure, leaving a final closure rate of 97.1% (33/34). Five patients (15%) required topical therapy for postoperative myringitis. Mean (SD) pure-tone average and air-bone gap significantly improved by 11.5 (10.7) dB ( P < .001) and 11.4 (10.6) dB ( P < .001), respectively. Twenty-seven patients (79%) closed their air-bone gap within 20 dB. Conclusion Transcanal endoscopic lateral cartilage graft tympanoplasty is feasible, and initial data support favorable outcomes. Further data are necessary for evaluation of long-term results and efficacy comparisons.

Minimally invasive tympanoplasty: review of outcomes and technical refinements

“…near-total perforations and also perforations with extensive myringitis 18 . This study revealed a GIR of 88% with a tragal cartilage-perichondrium graft and statistically significant ABG improvement of 13.8 dB.…”

Anatomy and Surgical Approach of the Ear and Temporal Bone

“…The surgery is typically performed by making incisions in the posterior ear canal skin adjacent to the tympanic membrane. The canal skin and tympanic membrane are elevated together, which allows the surgeon to visualize the entire middle ear space [10]. Fixation or erosion of the malleus, incus or stapes can be repaired using a tympanoplasty approach using either autologous material or prosthetic materials (PORP-partial ossicular replacement prosthesis, TORP-total ossicular replacement prosthesis).…”

Commentary on: “Endoscopic Lateral Cartilage Graft Tympanoplasty”

“…The previously elevated canal skin is repositioned on the anterior canal wall with slight overlap onto the cartilage-perichondrium graft, and the vascular strip is returned to its original position over the pedicled perichondrium. 1…”