Clin Exp Otorhinolaryngol.  2023 May;16(2):125-131. 10.21053/ceo.2022.01599.

Outcomes of Endoscopic Tympanoplasty for Large Perforations: A Multicenter Retrospective Study in South Korea

• Choi SW
• Moon IJ
• Choi JE
• Kang WS
• Moon IS
• Kong SK
• Cho HH
• Lee IW
• Chung JW
• Hur DG
• Lee JD

• KMID: 2542353
• DOI: http://doi.org/10.21053/ceo.2022.01599

Abstract

Objectives
. Endoscopic tympanoplasty (ET) provides minimally invasive transcanal access to the middle ear and improves middle ear visibility for the treatment of tympanic membrane (TM) perforations. However, the literature on surgical outcomes for large TM perforations is lacking and limited to small series. This study aimed to evaluate the clinical benefits of ET for large TM perforations.
Methods
. This retrospective cohort study was conducted at nine tertiary referral hospitals in South Korea, where 252 patients who underwent ET as primary surgery from September 2019 to August 2021 were included. The outcome measures included the graft success rate and pre- and postoperative audiometric data.
Results
. In 239 patients, the graft success rate of ET for large or subtotal perforations was 86.2% (206 patients), while the graft failure rate was 13.8% (33 patients). The graft failure rate was directly correlated with surgical techniques, including overlay and medial or lateral underlay tympanoplasty (P=0.027). Lateral underlay tympanoplasty showed the most favorable results. Sex, laterality, etiology, site and size of perforation, operation time, and graft materials did not vary significantly between the graft success and failure groups (P>0.05). The mean air-bone gap (ABG) improved significantly in both groups (graft success group: 10.0±0.6 dB and graft failure group: 7.7±0.3 dB; P<0.001). However, the ABG improvement did not significantly differ between the groups. Analysis of covariance revealed that the postoperative 500-Hz bone conduction threshold improved after successful ET (adjusted coefficient, –11.351; 95% confidence interval, –21.491 to –1.212; P=0.028).
Conclusion
. This study involved the largest population to date of large TM perforations treated by ET. The study findings suggest that ET is feasible and effective in treating large TM perforations.

Keyword

Tympanic Membrane Perforation; Minimally Invasive Surgery; Endoscopy; Tympanoplasty

Figure

• 

  Fig. 1. Regression analysis comparing postoperative improvements in air conduction (AC) and bone conduction (BC) between tympanoplasty with graft failure and tympanoplasty with graft success. (A) AC at 500 Hz, (B) AC at 1,000 Hz, (C) AC at 2,000 Hz, (D) AC at 4,000 Hz, (E) BC at 500 Hz, (F) BC at 1,000 Hz, (G) BC at 2,000 Hz, (H) BC at 4,000 Hz. Post, postoperative; Pre, preoperative.

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