Prospective Comparison of Pediatric Endoscopic Lateral Graft and Interlay Tympanoplasty

Ranguis, Sebastian; Leonard, Colin G; James, Adrian

doi:10.1097/mao.0000000000003053

Cited by 4 publications

(2 citation statements)

References 30 publications

(71 reference statements)

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“…The interlay graft technique was introduced to endoscopic practice, having been recommended by Dr David Pothier (personal communication) as ideally suited for endoscopic graft placement. While graft placement is certainly easier, and closure rates comparable, 15 we did not find an appreciable time saving from the technique in this study: elevation of the squamous layer from the fibrous layer can be difficult to complete without trapping squamous cells under the graft, and in the few cases included this study we found it to be more time-consuming than the more extensive complete meatal skin flap elevation required for lateral graft tympanoplasty. 15 The additional time requirement for graft harvest, wound morbidity, and limitation of the smaller size of the pediatric tragus are reasons why cartilage grafting is usually reserved for ear drums associated with a risk of retraction, in our practice.…”

Section: Discussionmentioning

confidence: 53%

Time Flow Study to Assess Opportunities to Improve Efficiency in Endoscopic Tympanoplasty

Swarup¹,

Chayaopas²,

Eastwood

et al. 2021

Int Adv Otol

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BACKGROUND To characterize the workflow during transcanal totally endoscopic tympanoplasty by recording the time and instrumentation used for different steps in the procedure. This analysis aims to identify aspects of instrumentation and surgical technique that could be modified to improve surgical efficiency. METHODS Thirty-one endoscopic tympanoplasty procedures were observed at a single academic center. Patient age ranged from 2.7 to 17.8 years. The procedure was separated into distinct steps. The duration in minutes and the instruments used were recorded by an independent observer. RESULTS Raising the tympanomeatal flap (median 9.82 minutes) and positioning the graft and replacing the flap (median 9.13 minutes) took significantly longer than all other steps (P > .05, Wilcoxon method). Teaching a trainee significantly increased step duration by a total of 32.8 minutes (P > .05, Wilcoxon method). There was no correlation between age of the patient, side of the ear, surgical technique, or graft type, and duration of surgery. Suction instruments with a functional tip (dissector or knife tip) were most commonly used to dissect and maneuver soft tissue while maintaining the surgical field clear of blood. CONCLUSION As elevation of the tympanomeatal flap and graft placement are the most time-consuming steps in endoscopic tympanoplasty, especially for surgical trainees, surgical efficiency could most dramatically be enhanced by modification of instrumentation or technique to facilitate these steps. Modification of simpler steps such as hair trimming and ear canal packing have less potential for shortening surgical duration.

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Section: Discussionmentioning

confidence: 53%

Time Flow Study to Assess Opportunities to Improve Efficiency in Endoscopic Tympanoplasty

Swarup¹,

Chayaopas²,

Eastwood

et al. 2021

Int Adv Otol

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“…In fact, considering the endoscopic advantages of close proximity and magnification, the interlay technique may be an option in endoscopic surgery. Most recently, the effectiveness of the interlay technique in TEES was reported [ 19 ]. However, the authors limited the patients to children with small perforations and did not report specific methods and tips.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic tympanoplasty type I using interlay technique

Takahashi

Motegi

Yamamoto

et al. 2022

Journal of Otolaryngology - Head & Neck Surgery

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Background Tympanoplasty using the interlay technique has rarely been reported in transcanal endoscopic ear surgery, unlike the underlay technique. This is because many surgeons find it challenging to detach the epithelial layer of the tympanic membrane using only one hand. However, the epithelial layer can be easily detached from the inferior part of the tympanic membrane. Another key point is to actively improve anteroinferior visibility even if the overhang is slight because most perforations and postoperative reperforations are found in the anteroinferior quadrant of the tympanic membrane. We report the application of the interlay technique in endoscopic tympanoplasty type I for tympanic perforations. Methods We retrospectively reviewed the medical records of 51 patients who had undergone tympanoplasty using the interlay technique without ossiculoplasty between 2017 and 2020. We then compared the data with those of patients who underwent microscopic surgery (MS) using the underlay technique between 1998 and 2009 (n = 104). No other technique was used in each group during this period. Repair of tympanic membrane perforation and hearing outcomes were assessed for > 1 year postoperatively. Results The perforation sites were limited to the anterior, posterior, and anterior–posterior quadrants in 23, 1, and 27 ears, respectively. Perforations were closed in 50 of the 51 ears (98.0%), and the postoperative hearing was good (average air-bone [A-B] gap was 6.8 ± 5.8 dB). The surgical success rate for the repair of tympanic membrane perforation was not significantly different from the MS group (93.3%, P = 0.15). The average postoperative average A-B gap in the group that underwent the interlay technique was significantly different from that in the MS group (10.1 ± 6.6 dB, P < 0.01). Conclusion The interlay technique should be considered as one of the treatment methods in endoscopic surgery for tympanic perforations. Further study of the postoperative outcomes of this procedure should be conducted to establish the optimal surgical procedure for tympanic perforations. Trial registration: This study was retrospectively approved by the Institutional Review Board of the Jikei University, Tokyo, Japan (approval number: 32-205 10286). Video abstract

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Totally endoscopic tympanic membrane repair

James

2021

HNO

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Prospective Comparison of Pediatric Endoscopic Lateral Graft and Interlay Tympanoplasty

Abstract: Supplemental Digital Content is available in the text

Cited by 4 publications

References 30 publications

Time Flow Study to Assess Opportunities to Improve Efficiency in Endoscopic Tympanoplasty

Time Flow Study to Assess Opportunities to Improve Efficiency in Endoscopic Tympanoplasty

Endoscopic tympanoplasty type I using interlay technique

Totally endoscopic tympanic membrane repair

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