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To detach or not to detach the umbo in type I tympanoplasty: functional results

  • Otology
  • Published:
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Abstract

Purpose

To compare the audiological outcomes, tympanic membrane (TM) healing rates and complication rates in patients undergoing endoscopic underlay and over–under tympanoplasty type I (TTI).

Methods

The study includes 95 patients who underwent endoscopic TTI in the period between 2018 and 2023: 56% of the patients had the underlay technique and 41% had the over–under technique. Data regarding pre- and postoperative hearing, perforation characteristics, surgical procedures, graft types and complications were retrospectively analyzed. Audiometrical assessment included air conduction (AC) and bone conduction (BC) pure tone averages (PTA) and air–bone gap (ABG), pre- and postoperatively.

Results

Both underlay and over–under techniques significant improved AC PTA, with a mean ABG improvements of 5.9 dB and 7.2 dB, respectively. There was no significant difference in BC PTA between pre- and post-operative, indicating no inner ear damage in both techniques. The over–under technique showed a significantly higher TM closure rate (94.4%) compared to the underlay technique (80.6%). Complications were rare, with only one case of TM lateralization requiring revision surgery.

Conclusions

Endoscopic TTI is an effective treatment in improving auditory function in chronic middle ear diseases. In our cohort, the detachment of the umbo does not negatively influence the postoperative hearing results and does not increase rate of complications. Moreover, the over–under technique demonstrates superior TM closure rates, making it a valuable option for specific cases. However, future prospective studies with larger sample sizes and longer term follow-up are needed to validate these findings and provide more comprehensive insights.

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Data availability

Data are available upon request to the author.

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Author notes

  1. Cecilia Lotto, Raffael Fink, Giulia Molinari, and Lukas Anschuetz are the contributing first and last authors.

Authors and Affiliations

  1. Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

    Cecilia Lotto, Ignacio J. Fernandez, Livio Presutti & Giulia Molinari

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

    Cecilia Lotto, Raffael Fink, Sven Beckmann, Marco Caversaccio & Lukas Anschuetz

  3. Institute of Medical Education, University of Bern, Bern, Switzerland

    Daniel Stricker

  4. Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Università di Bologna, Bologna, Italy

    Ignacio J. Fernandez, Livio Presutti & Giulia Molinari

Authors
  1. Cecilia Lotto
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  2. Raffael Fink
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  7. Marco Caversaccio
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  8. Giulia Molinari
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  9. Lukas Anschuetz
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Corresponding author

Correspondence to Cecilia Lotto.

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Conflict of interest

The authors declare no conflict of interest.

Ethical approval

All procedures involving human participants were in accordance with the ethical standards of the national research committee and with the World Medical Association Declaration of Helsinki (2002). In the case of research conducted at Inselspital in Bern, approval for the study was granted by the institutional and regional review board (Kantonale Ethikkomission, KEK-BE 2019‐00555).

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Lotto, C., Fink, R., Stricker, D. et al. To detach or not to detach the umbo in type I tympanoplasty: functional results. Eur Arch Otorhinolaryngol 281, 2871–2876 (2024). https://doi.org/10.1007/s00405-023-08370-6

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  • DOI: https://doi.org/10.1007/s00405-023-08370-6

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