Comparative Study of Outcome of Tympanoplasty between Endoscopic and Microscopic Approach

Background: Tympanoplasty is a common operation performed by ENT specialist. It is a challenging event to treat with a microscope when the external canal is narrow or overhang. The endoscopic permeatal approach gives the advantage of wide angle view and can avoid post-auricular approach and canaloplasty. The aim of the study was to compare the outcome of tympanoplasty in post-auricular microscopic and permeatal endoscopic approach.Material &Methods:A total of 100 patients between the age group 15 to 44 years who were attending the ENT OPD, suffering from Chronic Suppurative Otitis Media (CSOM) were selected on the basis of perforation type and their workup was done to assess the candidature for tympanoplasty. Comparative analysis between the two groups were done based on analysis using SPSS 24 software version. The level of significance was set to 5% (P<0.05).Results:A total of 100 patients were included in the study the overall graft take was 92.3% in cases of Endoscopic permeatal technique as compared to 88.88% in the case of Microscopic postaural underlay technique, with a majority of the failures in the large central perforation group rendering a p = 0.021 for patients operated for Large perforations, p=0.036 or moderate perforations and p = 0.0476 for small perforations. There was a difference in hearing improvement with majority of the cases improving to the range of 10-21 dB in permeatal endoscopic technique compared to 07-18 dB in postauralMicroscopic technique.Conclusion:In terms of graft take rate, hearing improvement and complications, the permeatal endoscopic method outperforms the postauricular microscopic approach.

Endoscopic type I tympanoplasty in 70 patients with chronic otitis media: A preliminary report

Objective@#To evaluate the preliminary surgical results of Endoscopic Type I Tympanoplasty among patients with inactive chronic otitis media without ossicular pathology. @*Methods@#Design: Prospective Series. Setting: Tertiary Government Hospital. @*Participants@#Seventy patients with inactive mucosal chronic otitis media (COM) with air bone gap (ABG) of ≤ 40 dB on the preoperative audiogram scheduled to undergo Type I Tympanoplasty between July 2018 and December 2020 were enrolled. @*Results@#Seventy-three (73) ears were evaluated. The overall rate of graft uptake was 95.9% at 12 weeks. There was a statistically significant (p<.001) improvement in hearing on comparison of pre-operative (25.74 ± 7.34 dB) and post-operative (14.82 ± 6.55 dB) air bone gap. The duration of surgery was less than one hour in 76.7% and 77.2 % patients experienced only mild post[1]operative pain. @*Conclusion@#Endoscopic tympanoplasty can provide good results with respect to graft uptake and hearing gain with short surgical duration and minimum postoperative morbidity. Longer follow up of at least 6 months (for graft uptake) and preferably not less than 12 months (for hearing results) may confirm our preliminary findings.

The Effect of Mastoidectomy Combined with Tympanoplasty Type I on Postoperative Hearing in Chronic Otitis Media Patients Older than 65 Years / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although canal wall up mastoidectomy (CWUM) has been performed frequently as a treatment for chronic otitis media (COM), the necessity of CWUM for non-cholesteatomatous COM (NCCOM) is still controversial. Since elderly people often have systemic problems, there is a high likelihood of side effects after general anesthesia, so it is important to judge the necessity of mastoidectomy. The purpose of this study was to investigate the effect of CWUM for the treatment of NCCOM in patients over 65 years of age. SUBJECTS AND METHOD: Forty-two cases of CWUM with tympanoplasty type I performed as a treatment for NCCOM from 2007 through 2016 were reviewed retrospectively. Pure tone audiometry was performed preoperatively and postoperatively, and preoperative temporal bone CT was used to evaluate the mastoid status. The valsalva maneuver (VM) was used to evaluate the eustachian tube function. RESULTS: The total number of patients was 42 and the success rate of eardrum repair was 92.8%. Comparison of hearing results taken preoperatively and postoperatively showed significant hearing improvement in both air conduction and air-bone gap. When hearing results were compared according to the mastoid status and the response of VM, there were no significant differences. CONCLUSION: Mastoidectomy combined with tympanoplasty type I showed a high success rate of ear drum repair and good hearing improvement, with no critical side effects. Therefore, mastoidectomy does not need to be limited by one's old age. Adequate mastoidectomy after proper consideration of the mastoid status will be helpful in the treatment of the disease.

Effect of Mastoidectomy and Posterior Tympanotomy on Postoperative Hearing / 대한이비인후과학회지

To evaluate the effect of mastoidectomy and posterior tympanotomy on postoperative hearing, 101 cases of type I tympanoplasty operated by one operator were retrospectively reviewed. The patients were divided into three groups; Group I(N=14) was the type I tympanoplasty without mastoidectomy ; Group II(N=44) was the type I tympanoplasty with simple mastoidectomy ; Group III(N=43) was the type I tympanoplasty and mastoidectomy with posterior tympanotomy. The type of operation was determined by preoperative physical finding, radiological findings, and decision was finally made during the operation. Preoperative mean air-bone gaps of pure tone average were significantly different among three groups(group I;13 dBHL; group II ; 22 dBHL, group III ; 31 dBHL). There was no significant difference of the postoperative air-bone gap gains at speech frequencies among three groups and the average gain was about 9 dBHL at 3 months, 11 dBHL at 6 months. respectively. However, the postoperative hearing was significantly changed according to the types of operation in the air and bone conduction, specially in the high tone area. At the 4 kHz, postoperative bone conduction did not changed significantly in the group I and II, however, postopearive bone conduction significantly worsened from 14 dBHL to 20-22 dBHL in the group III. In the same time, air conduction at 8 kHz was significantly aggravated from 52 dBHL to 65 dBHL postoperatively in the group III.