Objectives
To analyze and compare the available data about the outcomes of endoscopic and microscopic type I tympanoplasty.
Data sources
PubMed, Cochrane library Ovid, Scopus, Google scholar, and ...ClinicalTrials.
Methods
We conducted a meta-analysis in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We included comparative studies describing type I tympanoplasty, and comparing surgical outcomes of the endoscope with the microscope in terms of efficacy and safety.
Results
Our systematic search yielded 22 studies meeting the inclusion criteria and eligible for analysis. The pooled graft uptake rates and audiological results of endoscopic and microscopic tympanoplasty demonstrated non-significant differences. In contrast, endoscopic type I tympanoplasty outperforms microscopic tympanoplasty regarding a highly significant decrease not only in pooled mean operative time but also in the pooled complications rate.
Conclusions
Based on our meta-analysis, the surgical outcomes of endoscope-assisted and microscope-assisted type I tympanoplasty in terms of postoperative hearing outcomes and the graft uptake rate were comparable. On the contrary, operative time and complications rate proved to be significantly reduced with endoscopy compared to microscopy. Hence, the endoscope is as efficient as the microscope in type I tympanoplasty but less invasive, fewer in complications and shorter in operative time.
Key Points
Can the endoscope be a good alternative to the microscope in type I tympanoplasty?
Using the microscope in tympanoplasty has been the conventional procedure for repairing perforated tympanic membranes since the 1950s. However, ear surgeons have increasingly practised endoscope-assisted tympanoplasty since the late 1990s.
In this study, surgical outcomes of both techniques in terms of postoperative audiological results and the graft uptake rate were comparable.
In contrast, the endoscopic technique was superior to the microscopic one in terms of operative time and complications rate.
According to our study, the endoscope-Assisted type I tympanoplasty proved to be as effective as the microscopic technique but safer and less invasive.
To evaluate the effect of adding platelet rich plasma (PRP) or Hyaluronic acid (HA) to fat graft myringoplasty (FGM) for medium sized central tympanic membrane (TM) perforations.
This is a ...retrospective study conducted on 69 patients with medium sized central TM perforations. In 21 patients, PRP was used with the FGM; and in 23 patients, HA was used with the FGM; while in 25 patients, pure FGM was performed without adding an enhancing material.
Successful TM perforation repair was achieved in 18 ears (85.7) with using PRP with FGM and in 20 ears (87%) with using HA with FGM and in 15 ears (60%) with pure FGM.
FGM with adding PRP or HA is more successful in closure of TM perforation than pure FGM in case of medium sized central TM perforation.
Objective
The objective of this study was to compare the graft outcomes and complications of two endoscopic perichondrium–cartilage graft techniques for repairing large perforations.
Study design
...Single center blinded randomized controlled trial.
Materials and methods
61 large perforations more than 50% of TM area were prospectively randomized to undergo the free perichondrium and free cartilage graft group (FPFC,
n
= 31) or perichondrium partial attachment the cartilage graft group (PPAC,
n
= 30). The primary outcome measures were the operation time; secondary outcome measures were the graft success rate and hearing gain at 12 months postoperatively and postoperative complications.
Results
All patients completed follow-up of 12 months. The mean operation time was 38.2 ± 2.3 min in the FPFC group and 37.4 ± 5.6 min in the PPAC group (
P
= 0.658). At postoperative 3 months, the graft success rates were 96.7% in the FPFC group and 93.3% in the PPAC group (
P
= 0.976). At postoperative 12 months, the graft success rates were 96.7% in the FPFC group and 83.3% in the PPAC group (
P
= 0.182). However, the residual and re-perforation rate with no infection was 0.0% (0/31) in the FPFC group and 16.7% (5/30) in the PPAC group (
P
= 0.056).
N
o significant between-group differences were observed pre- (
P
= 0.842) or post- (
P
= 0.759) operative air bone gap (ABG) values or mean ABG gain (
P
= 0.886). However, granular myringitis has been noted in 6.5% in the FPFC group and in 3.3% in the PPAC group.
Conclusions
This study suggested that 12-month graft success and hearing gain were comparable between the perichondrium free and partial attachment the cartilage graft techniques, nevertheless, partial attachment technique could increase residual and re-perforations.
This study was performed to compare the operation time, graft outcomes and complications between the endoscopic cartilage-perichondrium button technique and over-under technique for repairing large ...perforations.
A total of 52 chronic large perforations were randomly allocated to receive treatment using the endoscopic cartilage-perichondrium button technique (
= 26) or over-under technique (
= 26). The graft outcomes, mean operation time and post-operative complications were compared between the two groups at 12 months.
The study population consisted of 52 patients with unilateral chronic large perforations. All patients completed 12 months of follow up. The mean operation time was 32.3 ± 4.2 minutes in the button technique group and 51.6 ± 2.8 minutes in the over-underlay technique group (
< 0.01). The graft success rate at 12 months was 92.3 per cent (24 out of 26) in the button technique group and 96.2 per cent (25 out of 26) in the over-underlay group (
= 0.552).
The endoscopic cartilage-perichondrium button technique had similar graft success rates and hearing outcomes for large chronic perforations to the over-under technique, but significantly shortened the mean operation time.
Objectives
The aim of this study was to explore the method of adding a secondary perichondrium patch to enhance the primary cartilage–perichondrium patch during endoscopic myringoplasty and to ...evaluate the effectiveness of this method in terms of healing rate and post-operative hearing of patients with poor prognostic factors (eustachian tube dysfunction, large perforations, subtotal perforations, and anterior marginal perforations).
Design
This retrospective study analyzed a total of 80 patients (36 females and 44 males, median age of 40.55 years) who had received a secondary perichondrium patch during endoscopic cartilage myringoplasty. Patients were followed up for 6 months. Healing rates, complications, preoperative and postoperative pure-tone average (PTA) and air–bone gap (ABG) were analyzed.
Results
At 6-month follow-up, the healing rate of tympanic membrane was 97.5% (78/80). The mean pure-tone average (PTA) improved from 43.18 ± 14.57 dB HL pre-operatively to 27.08 ± 9.36 dB HL 6 months after the operation (
P
= 0.002). Similarly, the mean ABG improved from 19.05 ± 5.72 dB HL pre-operatively to 9.36 ± 3.75 dB HL (
P
= 0.0019) at 6 months after the operation. Major complications were not observed during follow-up.
Conclusions
The use of a secondary perichondrium patch during endoscopic cartilage myringoplasty for large, subtotal and marginal tympanic membrane perforations achieved a high healing rate and a statistically significant hearing gain with low incidence of complications.
Assess clinical and functional outcomes of a modified palisade cartilage-perichondrium graft myringoplasty under local in an office setting.
Retrospective case series.
Tertiary care facility.
...Patients with a tympanic membrane perforation presenting between March 2013 and October 2017. Inclusion criteria included age ≥ 7 years, entire perforation margin visualized through a transcanal view, and the ability to lie supine for up to 45 min. Exclusion criteria included a conductive hearing loss larger than expected, and presence of active infection.
In-office modified myringoplasty technique under local anesthesia without sedation.
Complete perforation closure rate and audiometric outcomes.
250 patients underwent the procedure, of whom 13 had bilateral sequential procedures (total 263 ears). Of those, 197 were primary and 66 revision. Average age was 46.3 years. Perforation sizes were categorized as small (32), moderate (109), large (78), and subtotal (44). Complete perforation closure was evident in 219 of the 250 cases (88%). Preoperative mean air pure tone average (PTA) was 56.7 dB and mean bone PTA was 27.5 dB (pre-operative ABG 29.2 dB). AC-PTA significantly improved to 35.0 dB (p < 0.0001), and ABG to 9.6 dB (p < 0.0001). Only subtotal perforations showed a statistically significant negative relationship with outcome (p = 0.04).
The modified palisade cartilage-perichondrium graft myringoplasty under local anesthetic is a highly successful procedure well tolerated by adult and pediatric patients with variable perforation sizes. This may have significant potential patient benefits, as well as cost savings to the health care system.
Endoscope-assisted myringoplasty YADAV, S. P. S; AGGARWAL, N; JULAHA, M ...
Singapore medical journal,
05/2009, Letnik:
50, Številka:
5
Journal Article
Recenzirano
To date, myringoplasty conducted under the operating microscope has been found to have its limitations. With the introduction of the endoscope into other branches of surgery, there have been attempts ...at its utilisation in otology.
Endoscope-assisted myringoplasty was carried out in 50 patients aged 18-45 years using the temporalis fascia graft. The middle ear was examined through perforation in order to exclude cholesteatoma.
The overall success rate of the graft uptake and improvement in conductive deafness as air-bone gap closure was achieved in 80 percent of cases.
Endoscopic myringoplasty was found to be equally effective, less morbid and very cost-effective in small central perforations. However, it is not applicable in all cases, especially in those with large perforations.
Objective
To compare the outcome of endoscopic transtympanic cartilage myringoplasty with and without removal of perforation edges for repairing chronic perforations with mucosal chronic otitis media ...(COM).
Study design
Quasi‐randomised clinical trial.
Setting
Tertiary referral centre.
Materials and Methods
Patients with chronic perforations and mucosal COM undergoing endoscopic transtympanic cartilage myringoplasty were allocated to a control group for whom the perforation edges were preserved (n = 40) and an intervention group for whom the edges were removed (n = 39). Mean operation time, graft success rate, mean scores of graft neovascularisation and epithelialisation, and hearing were compared between the groups at 4 weeks and/or 6 months postoperatively.
Results
Graft success rate was 95% (38/40) in the control group and 97% (38/39) in the intervention group at 6 months postoperatively; the difference was not significant. Mean graft neovascularisation scores 4 weeks postoperatively were 2.52 ± 0.59 in the control group and 2.58 ± 0.55 in the intervention group; the difference was not significant. Mean graft epithelisation scores 4 weeks postoperatively were 1.48 ± 0.57 in the control group and 1.68 ± 0.51 in the intervention group; the difference was not significant and remained nonsignificant 6 months postoperatively (2.5 ± 0.55 vs. 2.76 ± 0.36). Audiological outcomes at 6 months did not differ between the groups.
Conclusion
Endoscopic, transtympanic cartilage underlay myringoplasty with preservation of the perforation margins did not affect graft neovascularisation, epithelialisation or success. Longer‐term outcomes and risk of cholesteatoma require further study.
Purpose
Based on a systematic review and meta-analysis, our study aimed to provide information about the factors that influence the success of tympanic membrane reconstruction.
Methods
Our systematic ...search was conducted on November 24, 2021, using the CENTRAL, Embase, and MEDLINE databases. Observational studies with a minimum of 12 months of follow-up on type I tympanoplasty or myringoplasty were included, while non-English articles, patients with cholesteatoma or specific inflammatory diseases, and ossiculoplasty cases were excluded. The protocol was registered on PROSPERO (registration number: CRD42021289240) and PRISMA reporting guideline was used. Risk of bias was evaluated with the QUIPS tool. A random effect model was used in the analyses. Primary outcome was the rate of closed tympanic cavities.
Results
After duplicate removal, 9454 articles were found, of which 39 cohort studies were included. Results of four analyses showed significant effects: age (OR: 0.62, CI 0.50; 0.78,
p
value: 0.0002), size of the perforation (OR: 0.52, CI 0.29; 0.94,
p
value: 0.033), opposite ear condition (OR: 0.32, CI 0.12; 0.85,
p
value: 0.028), and the surgeon’s experience (OR: 0.42, CI 0.26; 0.67,
p
value: 0.005), while prior adenoid surgery, smoking, the site of the perforation, and discharge of the ear did not. Four factors: etiology, Eustachian tube function, concomitant allergic rhinitis, and duration of the ear discharge were analyzed qualitatively.
Conclusions
The age of the patient, the size of the perforation, the opposite ear status, and the surgeon’s experience have a significant effect on the success of tympanic membrane reconstruction. Further comprehensive studies are needed to analyze the interactions between the factors.
Level of evidence
Not applicable.
Objective
We compare the long-term efficacy of the cartilage–perichondrium modified over-underlay technique and transtympanic underlay alone technique using endoscopic myringoplasty without ...tympanomeatal flap elevating for repairing large chronic perforations.
Material and methods
Nine chronic large perforations with mucosal chronic otitis media were recruited and randomly allocated to endoscopic cartilage–perichondrium modified over-underlay myringoplasty (MOUM,
n
= 55) and endoscopic cartilage–perichondrium transtympanic underlay alone myringoplasty (TUAM,
n
= 54). The graft success rate, hearing gain, mean operation time and postoperative complications were compared between the groups at 6 and 24 months.
Results
In total, 99 patients were finally analysed. The graft success rates 6 months after surgery between MOUM and TUAM groups were not significantly different (100.0% vs 96.0%,
p
= 0.484). However, the MOUM group had a significantly higher success rate 24 months after surgery than the TUAM group (93.9% vs 76.0%,
p
= 0.028). In addition, postoperative ABG < 10 dB was 73.5% patients in the MOUM group and 76.0% in the TUAM group, the difference wasn’t significant (
p
= 0.953). CT examination revealed well-pneumatised middle ears 24 months after surgery in both groups, and no middle ear cholesteatoma was observed.
Conclusion
Endoscopic modified cartilage–perichondrium over-underlay myringoplasty without tympanomeatal flap elevating is reliable and effective for repairing large perforations. It improves the long-term graft success rate compared to the endoscopic cartilage–perichondrium transtympanic underlay alone technique. The risk for iatrogenic cholesteatoma is minimal.
