Endoscopic Versus Microscopic Type I Tympanoplasty: An Updated Systematic Review and Meta-analysis.

OBJECTIVE: Our objective was to perform a systematic review and meta-analysis comparing the clinical outcomes after endoscopic and microscopic type I tympanoplasty. STUDY DESIGN: Randomized controlled trials, two-arm prospective studies, and retrospective studies were included. SETTING: Medline, Cochrane, EMBASE, and Google Scholar databases were searched until March 1, 2022 using the combinations of search terms: "endoscopic," "microscopic," and "tympanoplasty." METHODS: Two independent reviewers utilized the abovementioned search strategy to identify eligible studies. If any uncertainty existed regarding eligibility, a third reviewer was consulted. Primary outcome measures were graft success rate, air-bone gap (ABG) improvement, and operative time. Secondary outcomes were the rate of need for canalplasty, the proportion of self-rated excellent cosmetic results, and pain visual analog scale (VAS). RESULTS: Forty-three studies enrolled a total of 3712 patients who were undergoing type I tympanoplasty and were finally included. The pooled result showed endoscopic approach was significantly associated with shorter operative time (difference in means: -20.021, 95% confidence interval [CI]: -31.431 to -8.611), less need for canalplasty (odds ratio [OR]: 0.065, 95% CI: 0.026-0.164), more self-rated excellent cosmetic results (OR: 87.323, 95% CI: 26.750-285.063), and lower pain VAS (difference in means: -2.513, 95% CI: -4.737 to -0.228). No significant differences in graft success rate or ABG were observed between the two procedures. CONCLUSION: Endoscopic type I tympanoplasty provides a similar graft success rate, improvement in ABG, and reperforation rate to microscopic tympanoplasty with a shorter operative time, better self-rated cosmetic results, and less pain. Unless contraindicated, the endoscopic approach should be the procedure of choice in type I tympanoplasty.

Factors associated with the development of paediatric chronic otitis media by age nine: a prospective longitudinal cohort study of 6560 children.

OBJECTIVE: This study aimed to analyse social, health and environmental factors associated with the development of chronic otitis media by age nine. METHOD: This was a prospective, longitudinal, birth cohort study of 6560 children, reviewed at age nine. Chronic otitis media defined as previous surgical history or video-otoscopic changes of tympanic membrane retraction, perforation or cholesteatoma. Non-affected children were used as the control group. RESULTS: Univariate analysis demonstrated an association between chronic otitis media and otorrhoea, snoring, grommet insertion, adenoidectomy, tonsillectomy, hearing loss, abnormal tympanograms and preterm birth. Multivariate analysis suggests many of these factors may be interrelated. CONCLUSION: The association between chronic otitis media and otorrhoea, abnormal tympanograms and grommets supports the role of the Eustachian tube and otitis media (with effusion or acute) in the pathogenesis of chronic otitis media. The role of snoring, adenoidectomy and tonsillectomy is unclear. Associations suggested by previous studies (sex, socioeconomic group, parental smoking, maternal education, childcare, crowding and siblings) were not found to be significant predictors in this analysis.

Effects of prolonged microscopic work on neck and back strain amongst male ENT clinicians and the benefits of a prototype postural support chair.

Musculoskeletal pain is a common occupational hazard experienced by surgeons. Ear, nose and throat (ENT) surgeons are predisposed to neck and back pain due to regular prolonged microscopic work. We conducted a prospective pilot study to investigate the effects of sustained microscopic work on the neck and back, its correlation to surgical experience and to assess the benefits of a prototype postural support chair (PSC) amongst 10 male, ENT clinicians. We used a subjective measure of time to fatigue and pain for the neck and back as well as objective readings from a surface electromyogram (sEMG). We found that an increase in surgical experience correlated with the time taken to experience fatigue and pain in the neck and back. This was corroborated by our sEMG findings. The PSC significantly delayed the sensations in the neck and also eliminated the difference seen amongst the varying seniority of clinicians.

Comparing electronic recording with a diagrammatic template versus traditional handwritten recording of tympanomastoid procedures: third audit cycle of 95 cases.

BACKGROUND: The middle ear and mastoid are complex three-dimensional structures and therefore tympanomastoid procedures require detailed documentation. Traditional written accounts can be inaccurate and difficult to interpret. METHODS: This audit of 95 patients compares the completion of essential operative details using: an all-electronic version of a standardised proforma with a diagrammatic template, a non-electronic version with a diagrammatic template, and a traditional handwritten template. RESULTS: The electronic template resulted in 81 per cent of essential operative items being recorded, compared to 78 per cent (p = 0.3) with a previous non-electronic template and 50 per cent (p = 0.0004) when using simple handwritten recording. CONCLUSION: An electronic proforma with a diagrammatic template improves the documentation and interpretation of tympanomastoid procedures compared to traditional handwritten records.

O uso de simuladores no aprendizado para cirurgia otológica / The use of simulators in the learning for otologic surgery

INTRODUÇÃO: A doutrina do "aprender fazendo" foi criada por Halsted e col. no início do século 20 criando o primeiro modelo de residência médica do mundo. Esse aprendizado se desenvolve em 3 fases: cognitiva, associativa e autônoma, por meio de uma curva ascendente. Os simuladores surgiram nos últimos anos como complementação à fase cognitiva, somando esforços para o treinamento, antes realizado apenas em modelos animais e em cadáveres, cada vez mais dificultado por dilemas médico-legais. OBJETIVO: Descrever e comparar os diversos tipos de simuladores disponíveis para o aprendizado de cirurgia otológica. SÍNTESE DOS DADOS: Os modelos de simuladores se dividem principalmente em modelos reais e virtuais, cada um contendo suas particularidades com pontos positivos e negativos. O ponto principal de cada um deles é o feedback sensitivo conferido por cada um deles, o que chamamos de realidade háptica: coloração da estrutura dissecada; audição de sons correspondentes, como o da broca ou do aspirador; presença de pedal para acionamento da broca; possibilidade de aspiração do conteúdo dissecado; presença de joystick que simule a caneta do motor; utilização de óculos ou mesmo microscópio para visualização tridimensional; utilização de instrumental cirúrgico otológico real. O custo dos diferentes tipos de simuladores é também um ponto crucial para a implementação dos mesmos na realidade diária dos centros de treinamento. É importante citar que alguns desses simuladores permitem que os alunos em treinamento possam ser avaliados objetivamente pelo próprio simulador. CONCLUSÃO: Simuladores são vistos como ferramenta complementar para treinamento e aprimoramento de cirurgiões otológicos.

INTRODUCTION: The teaching method of "learn by doing it'' was created by Halsted e col. In the beginning of 20th century creating the first model of medical residence in the world. This learning develops in three phases: cognitive, associative and autonomous, through an ascending curve. The simulators appeared in the last years as a complement to the cognitive phase, adding efforts to the training, performed before only in animals and cadavers, ever more hampered by medical and legal dilemmas. OBJECTIVE: Describe and compare the various types of simulators available for the learning of otological surgery. DATA SYNTHESIS: The model of simulators are divided mainly in real and virtual models, each having its peculiarities with positive and negative points. The main point of each one of them is the sensory feedback granted by each one of them, what we call it haptic reality: coloring of the structure dissected; listening to the corresponding sounds; as the drill or vacuum; presence of a joystick that simulates the pen motor; use of glasses or even a microscope for three dimensional view; use of a real otologic surgical instrument. The cost of the differents types of simulators is also a key point for the implementation of them in the daily reality of the training centers. Is important to mention that some of these simulators allow the training students and can be objectively evaluated by the simulator itself. CONCLUSION: Simulators are seen as a complementary tool for training and improvement of the otological surgeons.

Cirurgia endoscópica de ouvido: dissecção da orelha média / Ear endoscopic surgery: dissection of the middle ear

Introdução: Endoscópios são equipamentos utilizados com sucesso em diversos procedimentos de várias especialidades médicas. Entretanto, na área da otologia, mesmo com a incorporação dos endoscópios em procedimentos conjuntos com microscópio, os procedimentos puramente assistidos por endoscopia ainda são muito limitados. Objetivo: Realizar dissecção endoscópica transcanal e transcanal modificada da orelha média, mostrando marcos anatômicos importantes além das estruturas que podem ser visualizadas através deste acesso. Tipo de Estudo: Prospectivo. Método: Em maio de 2009, 10 peças de ossos temporais foram dissecadas pelo mesmo cirurgião com auxílio de endoscópios. Utilizamos instrumentos de 0 e 45 graus e 4 mm, os mesmos empregados em cirurgias naso-sinusais. Resultados: Não houve dificuldades técnicas maiores na realização das dissecções. Fomos capazes de identificar várias estruturas-chave tais como a articulação incudo-maleolar, segmento timpânico do nervo facial, canal semi-circular lateral e additus ad antrum, isto sem provocar lesões em estruturas da orelha média. Conclusão: A dissecção endoscópica da orelha média pelas vias transcanal e transcanal modificada é possível e possibilita excelente visualização de estruturas importantes na orelha média. As técnicas de cirurgia de ouvido com endoscópio neste momento são semelhantes às microscópicas, porém algumas adaptações de instrumentos, novas técnicas e familiarização com estes aparelhos são fundamentais para o futuro.

Introduction: The endoscope is an equipment used successfully in several procedures of several medical specialties. However, in the otology area, even with incorporation of endoscopes in joint procedures with microscope, the procedures purely assisted by endoscopy are still very limited. Objective: Our work is aimed at carrying out transcanal and modified transcanal endoscopic dissection of the middle ear, by showing important anatomic marks, as well as the structures that may be viewed through this access. Type of Study: Prospective. Methods: In May 2009, 10 parts of temporal bones were dissected by the same surgeon with the help of endoscopes. We used instruments from 0 to 45 grads and 4 mm, the same that were applied in nasosinusal surgeries. Results: There was no major technical difficulty performing dissections. We could identify several key-structures such as incudo-malleolar articulation, tympanic segment of the facial nerve, lateral semi-circular canal and additus ad antrum, all without provoking lesions in the middle ear structures. Conclusion: The middle ear endoscopic dissection by transcanal and modified transcanal ways is possible and enables an excellent view of important structures in the middle ear. The ear surgery techniques with endoscope are currently similar to the microscopic ones, but some instrument adaptation, new techniques and familiarization with such appliances are critical for the future procedures.