Abstract:
Tympanic membrane perforations can be challenging depending on their location and on the anatomical characteristics of each individual. Endoscopic ear surgery (EES) offers a number of modifications to the traditional microscopic technique that help overcome those pitfalls. By enhancing the field of view and by carefully adapting a standardized technique and fashioning an ergonomic flap that adapts closely to its surrounding anatomy, outcomes in terms of reduced reperforation rates are satisfactory. Audiological results in the present series are limited, but demonstrate a trend towards improvement of the post-operative pure tone average (P<0.001) and a reduction in the air-bone gap.
Introduction
The management of anterior, subtotal or total tympanic membrane perforations can be challenging through a transcanal approach, especially through a narrow canal or with a prominent anterior overhang (1). Endoscopic views can provide a wider and more detailed image of the entire annulus by placing the objective lens in the external ear canal. This improves the visualization and facilitates the access to the anterior annulus, which can be often limited.
This study discusses the method and short-term results of transcanal endoscopic composite cartilage tympanoplasty for anterior and total perforations by customizing the steps previously described in the EES technique (2,3). In addition, we aim to present how modifying some of the steps in graft harvesting and placement better capitalize on the endoscopic view for the securement of the graft.
Methods
A retrospective analysis of the charts of patients undergoing tympanoplasty under this technique from 2010–2017 was performed by three different otologists in private and public hospitals across Sydney, Australia. All the perforations were medium to large or subtotal in size. Patients of all ages were included. Presence of cholesteatoma was an exclusion criterion. Audiological results are based on a smaller subset, as some patients failed to provide these results. Results were analyzed using SPSS/IBM® statistics software, Armonk, NY, USA. Paired sample analysis utilized Student t test. Statistical significance was obtained through the v2 test, and when appropriate. Fisher exact test was applied. An alpha value was considered significant when P<0.05.