Clin Exp Otorhinolaryngol.  2017 Mar;10(1):44-49. 10.21053/ceo.2016.00080.

Comparison of Endoscopic Tympanoplasty to Microscopic Tympanoplasty

• Choi N
• Noh Y
• Park W
• Lee JJ
• Yook S
• Choi JE
• Chung WH
• Cho YS
• Hong SH
• Moon IJ

• KMID: 2376407
• DOI: http://doi.org/10.21053/ceo.2016.00080

Abstract

OBJECTIVES
This study aimed to compare the outcome of endoscopic and microscopic tympanoplasty.
METHODS
This was a retrospective comparative study of 73 patients (35 males and 38 females) who underwent type I tympanoplasty at Samsung Medical Center from April to December 2014. The subjects were classified into two groups; endoscopic tympanoplasty (ET, n=25), microscopic tympanoplasty (MT, n=48). Demographic data, perforation size of tympanic membrane at preoperative state, pure tone audiometric results preoperatively and 3 months postoperatively, operation time, sequential postoperative pain scale (NRS-11), and graft success rate were evaluated.
RESULTS
The perforation size of the tympanic membrane in ET and MT group was 25.3%±11.7% and 20.1%±11.9%, respectively (P=0.074). Mean operation time of MT (88.9±28.5 minutes) was longer than that of the ET (68.2±22.1 minutes) with a statistical significance (P=0.002). External auditory canal (EAC) width was shorter in the ET group than in the MT group (P=0.011). However, EAC widening was not necessary in the ET group and was performed in 33.3% of patients in the MT group. Graft success rate in the ET and MT group were 100% and 95.8%, respectively; the values were not significantly different (P=0.304). Pre- and postoperative audiometric results including bone and air conduction thresholds and air-bone gap were not significantly different between the groups. In all groups, the postoperative air-bone gap was significantly improved compared to the preoperative air-bone gap. Immediate postoperative pain was similar between the groups. However, pain of 1 day after surgery was significantly less in the ET group.
CONCLUSION
With endoscopic system, minimal invasive tympanoplasty can be possible with similar graft success rate and less pain.

Keyword

Endoscopy; Tympanoplasty; Minimally Invasive Surgical Procedures; Pain

MeSH Terms

Ear Canal
Endoscopy
Humans
Male
Minimally Invasive Surgical Procedures
Pain, Postoperative
Retrospective Studies
Transplants
Tympanic Membrane
Tympanoplasty*

Figure

• 

  Fig. 1. Details of tympanoplasty. (A) Postauricular incision for microscopic postauricular tympanoplasty. (B) Microscopic view of operation field of tympanoplasty. (C) Endoscopic view of middle ear cavity during endoscopic tympanoplasty. (D) View of transcanal incision (white arrow heads) approach in endoscopic tympanoplasty.

• 

  Fig. 2. Comparison of pain scales between the endoscopic and microscopic tympanoplasty group at immediate, 3 to 6 hours, and 1 day after surgery. VAS, visual analogue scale.

• 

  Fig. 3. Comparison of 4.0 kHz bone conduction between the endoscopic and microscopic tympanoplasty group. Pre- and postoperative bone conduction was not significantly changed in the endoscopic tympanoplasty group, but bone conduction hearing threshold was significantly elevated after surgery in the microscopic tympanoplasty group.

Reference

1. Zollner F. The principles of plastic surgery of the sound-conducting apparatus. J Laryngol Otol. 1955; Oct. 69(10):637–52.

2. Dornhoffer JL. Hearing results with cartilage tympanoplasty. Laryngoscope. 1997; Aug. 107(8):1094–9.

3. Thomassin JM, Duchon-Doris JM, Emram B, Rud C, Conciatori J, Vilcoq P. Endoscopic ear surgery: initial evaluation. Ann Otolaryngol Chir Cervicofac. 1990; 107(8):564–70.

4. Marchioni D, Alicandri-Ciufelli M, Piccinini A, Genovese E, Presutti L. Inferior retrotympanum revisited: an endoscopic anatomic study. Laryngoscope. 2010; Sep. 120(9):1880–6.

5. Ayache S, Tramier B, Strunski V. Otoendoscopy in cholesteatoma surgery of the middle ear: what benefits can be expected? Otol Neurotol. 2008; Dec. 29(8):1085–90.

6. Migirov L, Shapira Y, Horowitz Z, Wolf M. Exclusive endoscopic ear surgery for acquired cholesteatoma: preliminary results. Otol Neurotol. 2011; Apr. 32(3):433–6.

7. Thomassin JM, Korchia D, Doris JM. Endoscopic-guided otosurgery in the prevention of residual cholesteatomas. Laryngoscope. 1993; Aug. 103(8):939–43.

8. Good GM, Isaacson G. Otoendoscopy for improved pediatric cholesteatoma removal. Ann Otol Rhinol Laryngol. 1999; Sep. 108(9):893–6.

9. Presutti L, Marchioni D, Mattioli F, Villari D, Alicandri-Ciufelli M. Endoscopic management of acquired cholesteatoma: our experience. J Otolaryngol Head Neck Surg. 2008; Aug. 37(4):481–7.

10. Badr-el-Dine M. Value of ear endoscopy in cholesteatoma surgery. Otol Neurotol. 2002; Sep. 23(5):631–5.

11. Tarabichi M. Endoscopic management of limited attic cholesteatoma. Laryngoscope. 2004; Jul. 114(7):1157–62.

12. Marchioni D, Mattioli F, Alicandri-Ciufelli M, Presutti L. Endoscopic approach to tensor fold in patients with attic cholesteatoma. Acta Otolaryngol. 2009; Sep. 129(9):946–54.

13. Tarabichi M. Transcanal endoscopic management of cholesteatoma. Otol Neurotol. 2010; Jun. 31(4):580–8.

14. Marchioni D, Villari D, Alicandri-Ciufelli M, Piccinini A, Presutti L. Endoscopic open technique in patients with middle ear cholesteatoma. Eur Arch Otorhinolaryngol. 2011; Nov. 268(11):1557–63.

15. Presutti L, Gioacchini FM, Alicandri-Ciufelli M, Villari D, Marchioni D. Results of endoscopic middle ear surgery for cholesteatoma treatment: a systematic review. Acta Otorhinolaryngol Ital. 2014; Jun. 34(3):153–7.

16. Dundar R, Kulduk E, Soy FK, Aslan M, Hanci D, Muluk NB, et al. Endoscopic versus microscopic approach to type 1 tympanoplasty in children. Int J Pediatr Otorhinolaryngol. 2014; Jul. 78(7):1084–9.

17. Kozin ED, Gulati S, Kaplan AB, Lehmann AE, Remenschneider AK, Landegger LD, et al. Systematic review of outcomes following observational and operative endoscopic middle ear surgery. Laryngoscope. 2015; May. 125(5):1205–14.

18. Bottrill I, Perrault DF Jr, Poe D. In vitro and in vivo determination of the thermal effect of middle ear endoscopy. Laryngoscope. 1996; Feb. 106(2 Pt 1):213–6.

19. Lempert J. Endaural, antauricular surgical approach to the temporal bone principles involved in this new approach: summary report of 1,780 cases. Arch Otolaryngol. 1938; May. 27(5):555–87.

20. Gulya AJ, Minor LB, Poe DS. Glasscock-Shambaugh’s surgery of the ear. 6th ed. Shelton, CT: People’s Medical Publishing House-USA;2010.

21. Marchioni D, Alicandri-Ciufelli M, Gioacchini FM, Bonali M, Presutti L. Transcanal endoscopic treatment of benign middle ear neoplasms. Eur Arch Otorhinolaryngol. 2013; Nov. 270(12):2997–3004.

22. Kozin ED, Lehmann A, Carter M, Hight E, Cohen M, Nakajima HH, et al. Thermal effects of endoscopy in a human temporal bone model: implications for endoscopic ear surgery. Laryngoscope. 2014; Aug. 124(8):E332–9.

23. Hanna BM, Kivekas I, Wu YH, Guo LJ, Lin H, Guidi J, et al. Minimally invasive functional approach for cholesteatoma surgery. Laryngoscope. 2014; Oct. 124(10):2386–92.

24. Barakate M, Bottrill I. Combined approach tympanoplasty for cholesteatoma: impact of middle-ear endoscopy. J Laryngol Otol. 2008; Feb. 122(2):120–4.