Total Endoscopic Perichondrium Reinforced Cartilage Myringoplasty for Anterior Perforation

Abstract

Objectives: To investigate the outcomes of graft uptake and hearing results in the repair of anterior perforation via a total endoscopic transcanal approach using a single or double perichondrium reinforced cartilage underlay technique. Study Design: Retrospective study. Setting: Tertiary referral hospital. Materials and Methods: We analyzed 65 patients who underwent surgery for anterior perforation. All surgeries were done via an endoscopic transcanal approach using tragal cartilage as graft, underlay technique reinforced with single or double perichondrium. Two groups were created in which group A had single perichondrium reinforcement and group B had double perichondrium. Graft uptake and hearing outcomes were evaluated between the two groups. Results: During the study period, 65 patients were included, of which 3 were lost to follow-up, and thus, only 62 patients were assessed. As for the surgical outcome, graft uptake was observed in 95.2% (n = 59) of patients, 6 months after the intervention. Graft uptake was not statistically significantly different between groups A and B and was 95% in both. There was a statistically significant improvement in hearing across the series overall, with no significant differences seen between group A and group B. Conclusions: The endoscopic approach for myringoplasty offers superior visualization, especially for anterior perforation avoiding postaural approach and canaloplasty. Endoscopic single or double perichondrium reinforced cartilage underlay technique is a reliable method for repair of anterior perforation. There is no difference in using single or double perichondrium reinforcement. Thus, we recommend using single or double perichondrium reinforcement depending on the need during the surgery.

Endoscopic Perichondrium-Cartilage Myringoplasty With Preserving of Anterior Margins and Tuck Grafts for Repairing Anterior Perforation With 3 year Followup

“…Previous studies showed that the graft success also depends on its location, besides the graft and the techniques used, the repair of an anterior or subtotal perforation is associated with a lower success rate than that of posterior or inferior perforations. 1 Although various surgical techniques were developed in recent years, these techniques required tympanomeatal flap elevation, or anterior canalplasty, and relatively advanced surgical skills to improve the anterior graft stabilization, which led to complicated surgical procedures, long operation time and slow healing. [4][5][6][7] In the cases of anterior protrusion of the EAC, it is difficult to remove the scar tissue of anterior margins, elevate the anterior tympanomeatal flap, and place the graft medial to anterior TM remnant even if endoscope is applied.…”

Endoscopic closure of tympanic membrane anterior perforation using a strip-type chondroperichondrial graft

“…They found that thinning or thickening of cartilage grafts did not prolong the operation or increased the technical difficulties; however, this did not lead to actual hearing gain or improved the success rate. [ 7 ] Therefore, in this study, we did not manipulate the thickness of the graft but directly removed most of the cartilage, leaving only the anterior strip-type structure. The results showed that our modification not only reduced the time for required graft shaping but also ensured postoperative hearing improvement and improved the graft success rate.…”

“…Studies have shown that TM perforations in the anterior quadrant are associated with lower surgical success rates than those in other quadrants because of insufficient visualization, poor vascularization, and poor stabilization. [ 7 ] The modifications of the underlay method include the mediolateral graft, window shade, loop overlay, and hammock techniques. Although improved, these operations necessitate postauricular incision, which extends the operating time and prolongs the postoperative recovery.…”

“…In contrast to microscopy, it provides panoramic vision with sufficient exposure of the anterior margins and satisfactory audiologic results, and it is minimally invasive. [ 6 , 7 ] Although anterior perforations can be safely managed with a transcanal endoscopic approach, the 1-handed mode of operation is often challenging for otologists. In particular, graft displacement and dislocation is liable to occur after placement of the graft, or when the flap is lifted to fill the cavity with a gelatin sponge.…”

Transcanal Endoscopic Retrograde Mastoidectomy for Cholesteatoma: A Prospective Study

“…Chronic otitis media is one of the common ear problems encountered by the otologist. 1 It can be divided as cholesteatomatous or noncholesteatomatous. 2 The pathogenesis of the cholesteatoma is still unknown.…”