Learning curve for endoscopic tympanoplasty type I: comparison of endoscopic-native and microscopically-trained surgeons

Abstract

Purpose Type I tympanoplasty is one of the first operations to be performed by ear surgeons in training and is increasingly performed using the endoscopic technique. The aim of the present study is to assess and compare the learning curve for type I tympanoplasties between a microscopically trained and endoscopic native ear surgeon. We hypothesize comparable learning curves between the two surgeons regardless of previous microscopic experience. Methods Retrospective analysis and comparison of the 25 first consecutive cases of type I tympanoplasty performed by a microscopically trained ear surgeon (MTES) and a native endoscopic ear surgeon (NEES). Results Mean duration of surgery in MTES and NEES groups was 54 ± 12.3 min and 55.6 ± 17.5 min, respectively. Both surgeons achieved a reduction of the surgery duration over time with statistically significant reduction from the first five cases to the last five cases in both groups. Graft intake rate was 92% after 3 months. Preoperative and postoperative PTA revealed a mean improvement of air bone gap (ABG) of 11.5 ± 7.1 dB HL in MTES group versus 9.3 ± 8.5 dB HL in NEES group, whereby the difference between the two groups was not statistically significant. Conclusion Endoscopic type I tympanoplasty shows comparable results and learning curves in two beginning endoscopic ear surgeons independent of the previous microscopic experience. We recommend if available the parallel learning of both techniques.

Minimally invasive tympanoplasty: review of outcomes and technical refinements

“…Especially in the setting of anterior perforations, the endoscope offers enhanced view on the perforation edges and may therefore facilitate correct positioning of the graft, although the latter might be more challenging in one-handed surgery 5 . This might be confirmed by the fact that the anatomical and functional results of endoscopic type I tympanoplasties by "native" endoscopic ear surgeons are comparable to those already trained in the microscopic technique 7 .…”

Outcomes and learning curve of endoscopic tympanoplasty: A retrospective analysis of 376 patients

“…The graft failure rate of type I ET is approximately 10%–15% 9–11 . Most study results have shown similar success rates for conventional microsurgery and endoscopic surgery 12 .…”

Transcanal Endoscopic Ear Surgery for Congenital Cholesteatoma: A Multi‐institutional Series

“…Several potential challenges and disadvantages of TEES are worth noting. A longer learning curve has been suggested, though this may be less relevant to current and future generations of surgeons who receive early training in endoscopic techniques 37 . One recent series even demonstrated a shorter operative time than a microscopic technique for the management of cholesteatoma 17 .…”

“…A longer learning curve has been suggested, though this may be less relevant to current and future generations of surgeons who receive early training in endoscopic techniques. 37 One recent series even demonstrated a shorter operative time than a microscopic technique for the management of cholesteatoma. 17 There is a loss of binocular vision that is afforded by the microscope; however, this is overcome by the dynamic visualization provided by the endoscope.…”