Comparison of temporal muscle fascia and tragal cartilage perichondrium in endoscopic type 1 tympanoplasty with limited elevation of tympanomeatal flap / Comparação entre fáscia do músculo temporal e pericôndrio de cartilagem tragal na timpanoplastia endoscópica tipo 1 com descolamento limitado do retalho timpanomeatal

Abstract Introduction Elevation of tympanomeatal flap is one of the basic steps of tympanoplasty. A satisfactory level of anatomic and functional success can be achieved by using different grafts with limited tympanomeatal flap elevation. Objectives We aimed to compare the anatomic and functional success of tragal cartilage perichondrium and temporal muscle fascia in cases of endoscopic type 1 tympanoplasty performed with limited tympanomeatal flap elevation. Methods In total, 81 cases (33 females, 48 males, mean age 22.1<±<10.1 years, interval 18-49 years) which underwent transcanal endoscopic type 1 tympanoplasty with limited elevation of tympanomeatal flap were included the present study. All cases were divided into two groups as tragal cartilage perichondrium (group A) and temporal muscle fascia (group B). The comparison of the groups were made considering the pre- and postoperative air-bone gap and the tympanic membrane status. Results There was no statistically significant difference between Group A and Group B in preoperative and in postoperative air-bone gap values (p<=<0.608 and 0.529, respectively). In Group A and B, postoperative air-bone gap values demonstrated significant decrease compared to the preoperative values (p<=<0.0001). Group A and group B did not demonstrate significant differences between postoperative improvements of air-bone gap values (p<=<0.687). Graft retention success was 92.6% in group A while it was 90.0% in group B. There was no statistically significant difference between the groups in terms of graft retention success (p<=<0.166). Conclusion In accordance with the results of this study, we believe that both tragal cartilage perichondrium and temporal muscle fascia, and also in limited tympanomeatal flap elevation in endoscopic tympanoplasty are all eligible for result in safe and successful surgery.

Resumo Introdução O descolamento do retalho timpanomeatal é uma das etapas básicas da timpanoplastia. Um nível satisfatório de sucesso na restauração anatômica e funcional pode ser alcançado com o uso de diferentes enxertos e descolamento limitado do retalho timpanomeatal. Objetivos Comparar os resultados anatômicos e funcionais entre o uso de pericôndrio de cartilagem tragal e de fáscia do músculo temporal em timpanoplastias endoscópicas tipo 1 feitas com descolamento limitado do retalho timpanomeatal. Método Foram incluídos no estudo 81 pacientes (33 mulheres, 48 homens, média de 22,1 ± 10,1 anos, variação de 18-49 anos), submetidos a timpanoplastia endoscópica transcanal tipo 1 com descolamento limitado do retalho timpanomeatal. Todos os casos foram divididos em dois grupos: pericôndrio da cartilagem tragal (grupo A) e fáscia do músculo temporal (grupo B). Na comparação dos grupos consideraram-se o gap aéreo-ósseo, pré e pós-operatório, e a condição da membrana timpânica. Resultados Não houve diferença estatisticamente significante entre os grupos A e B no pré e pós-operatório (p = 0,608 e 0,529, respectivamente). Nos grupos A e B, os valores do gap aéreo-ósseo no pós-operatório demonstraram redução significante em relação aos valores pré-operatórios (p = 0,0001). Os grupos A e B não demonstraram diferenças significantes entre as medidas pré e pós-operatórias dos valores dos gaps (p = 0,687). O sucesso da retenção do enxerto foi de 92,6% no grupo A, enquanto no grupo B foi de 90,0%, não ocorreu diferença estatisticamente significante entre os grupos (p = 0,166). Conclusão De acordo com os resultados deste estudo, acreditamos que tanto o pericôndrio da cartilagem tragal como a fáscia do músculo temporal, usados com descolamento limitado do retalho timpanomeatal na timpanoplastia endoscópica, são elegíveis para uma cirurgia segura e bem-sucedida.

The Effect of Endoscopic Tympanoplasty on Cochlear Function

OBJECTIVES: The aim of this prospective clinical study was to measure the audiologic outcomes of the patients that underwent endoscopic transcanal cartilage tympanoplasty, and to investigate the effects on cochlear function. METHODS: Thirty-three patients (33 ears) who were diagnosed with noncomplicated chronic otitis media and underwent endoscopic transcanal cartilage tympanoplasty technique were included. Pre- and postoperative first month distortion product otoacoustic emission (DPOAE) signal-to-noise ratio (SNR), bone conduction hearing levels and air bone gap (ABG) values were measured and total endoscope usage time was noted. RESULTS: Preoperative median SNR measurements at 0.5, 1, 2, and 4 kHz were 6 dB (1–11; interquartile range [IQR], 1), 6 dB (4–20; IQR, 1), 7 dB (3–26; IQR, 5) and 5.50 dB (0–9; IQR, 3), respectively. Postoperative median SNR measurements at 0.5, 1, 2, and 4 kHz were 6 dB (3–9; IQR, 1), 6 dB (2–21; IQR, 3), 7 dB (2–20; IQR, 3), and 6 dB (0–10; IQR, 7), respectively. Regarding the DPOAE measurements, there was no statistically significant difference between the SNR values of all given frequencies (P>0.05). Regarding the pure tone audiometry (PTA) measurements, bone conduction was significantly better at 0.5 and 1 kHz, postoperatively (P 0.05). Additionally, no statistically significant correlation was found between the SNR and PTA measurements and the endoscope usage time (P>0.05). CONCLUSION: We suggested that cochlear functions and sensorineural hearing remained stable after endoscopic transcanal cartilage tympanoplasty and cold light source doesn’t cause significant adverse effects cochlear functions.

Operative time and tympanic membrane graft uptake in endoscopic transcanal versus microscopic post-auricular tympanoplasty for chronic otitis media

Objective@#To compare surgical outcomes (operative time and tympanic membrane integrity) obtained by endoscopic transcanal tympanoplasty (ET) and microscopic post-auricular tympanoplasty (MT) in patient with inactive chronic otitis media. @*Methods@# Design: Retrospective Cohort Setting: Multicenter study in 3 Private Tertiary Hospitals Participants: 18 patients who underwent microscopic or endoscopic tympanoplasty for chronic otitis media. @*Results@#Each group had 9 patients, with median age of 43 (31-65 years) for the MT and 47 (29-59 years) for the ET group. There was no significant difference in median age of the two groups (Mann-Whitney U=17, P=.22). Male: female ratio was (5:4) and (6:3) for the ET and MT group respectively, with no significant difference in gender distribution (c2= 0.90, P=.34). Mean operative time for the ET and MT group was 86.7 minutes and 140.6 minutes, respectively, with significantly lower mean operative time for the ET group (t= 3.57, P=.0025). There was complete tympanic membrane graft uptake in both groups. @*Conclusion@#Regardless of technique, tympanoplasty is an effective surgical treatment among patients with inactive chronic otitis media. Endoscopic tympanoplasty is an alternative to conventional microscopic tympanoplasty that may use less operative time, producing similarly complete graft uptake.

Beneficios del abordaje endoscópico en miringoplastias / Endoscopic approach benefits in myringoplasties / Benefícios da abordagem endoscópica em miringoplastias

Introducción: la fisiopatología de las otitis medias crónicas simples está en estrecha relación con las rutas de ventilación del sistema tubo tímpano mastoideo, el cual tiene diversos estrechamientos o istmos que son suceptibles de presentar bloqueos de múltiples causas; por lo tanto es necesario que durante la resolución quirúrgica de esta patología se realice sistemáticamente la revisión de dichas rutas de ventilación. Objetivo: Demostrar los beneficios de la cirugía endoscópica de oído en la realización de miringoplastias. Material y métodos: Estudio descriptivo multicéntrico. Revisión de historias clínicas. Resultados: Se realizaron 54 miringoplastias mediante abordaje endoscópico transcanal con la correspondiente exploración de rutas de ventilación. Se evidenciaron 7,4% de casos con bloqueos en los diferentes diafragmas epitimpánicos. El porcentaje de reperforaciones fue del 9,25%. Conclusiones: Si bien la técnica de posicionamiento del injerto es similar a la utilizada tradicionalmente, en el presente estudio se evidenció un leve incremento del índice de reperforaciones a expensas del uso de pericondrio. El uso de técnica endoscópica en miringoplastia presenta una tasa de reperforación comparable a la de la biblografía actual, por lo tanto el principal beneficio sería la detección de bloqueos en las rutas de ventilación del oído medio.

Introduction: the pathophysiology of chronic otitis media simple is closely related with routes of ventilation of the tube tympanum mastoid system, which has several constrictions or istmus that are susceptible to have obstructions of multiple causes, therefore it is necessary that during the surgical resolution of this pathology the review of ventilation routes are systematically performed. Objective: To demonstrate the benefits of endoscopic ear surgery in the performance of myringoplasty. Material and methods: Multi-centre descriptive study, clinical histories review. Results: 54 cases of myringoplasty were performed using a transcanal endoscopic approach with ventilation routes exploration. 7,4% of cases presented blocks in the different epytimpanic diaphragms and the reperforation cases represented 9,25%. Conclusions: Although the technique of positioning the graft is the same as that traditionally used, in the present study there was a slight increase in the index of reperforation at the expense of perichondrium use. The use of endoscopic technique in myringoplasty has an index of reperforation comparable to the current bibliography. Therefore the main benefit would be the detection of blockages in the routes of ventilation in the middle ear.

Introdução: a fisiopatologia da otite média crônica simple esta estreitamente em relação com o sistema de ventilação mastóide tímpanico , que tem várias constrições ou istmos que são suscetíveis de apresentar fechaduras de múltiplas causas , portanto, é necessário que, durante a resolução cirúrgica desta patología a revisão das vias de ventilação seja realizada de forma sistemática. Objectivo: Demostrar os benefícios da cirurgia endoscópica na realização de miringoplastias. Material e métodos: Estudo descritivo multicenter, revisão de prontuários médicos. Resultados: 58 miringoplastias foram realizadas utilizando a abordagem endoscópica trasncanal com a correspondente exploração de rutas de ventilação. Em 7,4 % dos casos com bloqueios em os diferentes diafragmas epitimpánicos e o percentual de reperforaçoes foi de 9,25%. Conclusões: Enquanto a técnica de posicionamento de enxerto e semelhante aquela usada tradicionalmente, no presente estudo a um ligeiro aumento no índice de reperforaçoes a custa de usar pericondrio. A utilização da técnica endoscópica em miringoplastias tem una taxa de reperforação comparável com a bibliografia corrente, por conseguinte a principal vantagem seria a de detectar bloqueios nas rutas de ventilação do ouvido medio.