Skip to main content
SpringerLink
Log in

Endoscopic Cartilage Butterfly Tympanoplasty: A Two-Handed Technique with Endoscope Holder

  • Original Article
  • Published:
Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

The aim of the study was to evaluate and report the short-term results of two-handed endoscopic cartilage butterfly tympanoplasty using endoscope holders. The efficacy of the operative technique was evaluated and assessed by comparing the air–bone–gap on pure tone audiometry preoperatively and on follow-up at 6 months and 1-year post operatively. Patients with uncomplicated otitis media and healthy middle ear status with no ossicular involvement underwent endoscopic transcanal cartilage butterfly tympanoplasty. Small and medium sized tympanic membrane perforations were included in the study. Pre- and postoperative air–bone gaps and presence for any residual perforation was noted. A total 69 patients consisting of 45 males and 24 females with a mean age of 24.45 years were included in the study group. Small perforations involving only one quadrant were 39 in number while the medium sized perforations involving two quadrants were 26 in number and the ones involving three quadrants were 4 in number. At the end of the follow-up period of 6 months and 1 year, successful closure occurred in 67 of 69 patients with a success rate of 97.1%. The mean preoperative Air-Bone gap was 34 ± 3.45 dB which showed a steady decline on follow-up at 6 months 13 ± 4.53 and 15.34 ± 3.39 dB at 1 year following surgery. Recurrent perforation was noted in two patients involving three quadrants of the tympanic membrane. Endoscopic two-handed butterfly cartilage tympanoplasty can be safely performed in small and medium sized perforations with no middle ear disease/ossicular involvement. The hearing outcomes and successful closure rate are similar to those of other surgical methods. Our study uses the endoscope which provides superior image quality and the use of an endoscope holder makes the technique a two handed one, thereby making the manoeuvring of the microear instruments easier. Moreover, it can be performed under local anaesthesia with low complication rates and quick recovery. Level of Evidence Level 4.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Mudry A (2005) History of tympanoplasty. Otol Neurotol 26(3):554–555

    PubMed  Google Scholar 

  2. Zollner F (1955) The principles of plastic surgery of the sound-conducting apparatus. J Laryngol Otol 69(10):637–652

    Article  CAS  Google Scholar 

  3. Wullstein H (1956) Theory and practice of tympanoplasty. Laryngoscope 66(8):1076–1093

    Article  CAS  Google Scholar 

  4. Kim HJ, Kim MJ, Jeon JH, Kim JM, Moon IS, Lee WS (2014) Functional and practical outcomes of inlay butterfly cartilage tympanoplasty. Otol Neurotol 35(8):1458–1462

    Article  Google Scholar 

  5. Eavey RD (1998) Inlay tympanoplasty: cartilage butterfly technique. Laryngoscope 108(5):657–661

    Article  CAS  Google Scholar 

  6. Kaya I, Benzer M, Uslu M, Bilgen C, Kirazli T (2018) Butterfly cartilage tympanoplasty long-term results: excellent treatment method in small and medium sized perforations. Clin Exp Otorhinolaryngol 11(1):23–29

    Article  Google Scholar 

  7. Khan MM, Parab SR (2015) Concept, design and development of innovative endoscope holder system for endoscopic otolaryngological surgeries. Indian J Otolaryngol Head Neck Surg 67(2):113–119

    Article  Google Scholar 

  8. Parab SR, Khan MM (2018) New cartilage slicer for slicing techniques in tympanoplasty: design and applications. Indian J Otolaryngol Head Neck Surg. https://doi.org/10.1007/s12070-018-1467-4

    Article  PubMed  PubMed Central  Google Scholar 

  9. Khan MM, Parab SR (2016) Novel concept of attaching endoscope holder to microscope for two handed endoscopic tympanoplasty. Indian J Otolaryngol Head Neck Surg 68(2):230–240

    Article  Google Scholar 

  10. Khan MM, Parab SR (2016) Endoscopic cartilage tympanoplasty: a two-handed technique using an endoscope holder. The Laryngoscope 126:1893–1898. https://doi.org/10.1002/lary.25760

    Article  PubMed  Google Scholar 

  11. Khan MM, Parab SR (2011) Primary cartilage tympanoplasty: our technique and results. Am J Otolaryngol 32(5):381–387

    Article  Google Scholar 

  12. Khan MM, Parab SR (2013) Reinforcement of sliced tragal cartilage perichondrium composite graft with temporalis fascia in type I tympanoplasty: our techniques and results. J Rhinolaryng Otol 1:57–62

    Google Scholar 

  13. Khan MM, Parab SR (2012) Day care ear surgery: our experience of 4 years. Indian J Otolaryngol Head Neck Surg 64(3):280–284

    Article  Google Scholar 

  14. Khan MM, Parab SR (2014) Sliced Island tragal cartilage perichondrial composite graft: early results and experience. J Rhinolaryng Otol 2:4–9

    Google Scholar 

  15. Khan MM, Parab SR (2015) Comparative study of sliced tragal cartilage and temporalis fascia in type I tympanoplasty. J Laryngol Otol 129(1):16–22

    Article  CAS  Google Scholar 

  16. Khan MM, Parab SR (2015) Average thickness of tragal cartilage for slicing techniques in tympanoplasty. J Laryngol Otol 129(05):435–439

    Article  CAS  Google Scholar 

  17. Dornhoffer JL (1997) Hearing results with cartilage tympanoplasty. Laryngoscope 107(8):1094–1099

    Article  CAS  Google Scholar 

  18. Kartush JM (2000) Tympanic membrane Patcher: a new device to close tympanic membrane perforations in an office setting. Am J Otol 21(5):615–620

    CAS  PubMed  Google Scholar 

  19. Alain H, Esmat NH, Ohad H, Yona V, Nageris BI (2016) Butterfly myringo-plasty for total, subtotal, and annular perforations. Laryngoscope 126(11):2565–2568

    Article  Google Scholar 

  20. Ghanem MA, Monroy A, Alizade FS, Nicolau Y, Eavey RD (2006) Butterfly cartilage graft inlay tympanoplasty for large perforations. Laryngoscope 116(10):1813–1816

    Article  Google Scholar 

  21. Bhattacharya SN, Pal S, Saha S, Gure PK, Roy A (2016) Comparison of a microsliced modified chondroperichondrium shield graft and a tem-poralis fascia graft in primary type I tympanoplasty: a prospective randomized controlled trial. Ear Nose Throat J 95(7):274–283

    PubMed  Google Scholar 

  22. Mauri M, Lubianca Neto JF, Fuchs SC (2001) Evaluation of inlay butterfly cartilage tympanoplasty: a randomized clinical trial. Laryngoscope 111(8):1479–1485

    Article  CAS  Google Scholar 

  23. Glasscock ME 3rd, Jackson CG, Nissen AJ, Schwaber MK (1982) Postauric-ular undersurface tympanic membrane grafting: a follow-up report. Laryngoscope 92(7 Pt 1):718–727

    Article  Google Scholar 

  24. Wu PW, Wang WH, Huang CC, Lee TJ, Huang CC (2015) Comparison of short- and long-term hearing outcomes of successful inlay cartilage tympanoplasty between small and large eardrum perforations. Clin Exp Otorhinolaryngol 8(4):359–363

    Article  Google Scholar 

  25. Riss JC, Roman S, Morredu E, Farinetti A, Nicollas R, Triglia JM (2016) Butterfly-cartilage tympanoplasty in children: a 28-case series and literature review. Eur Ann Otorhinolaryngol Head Neck Dis 133(3):179–182

    Article  Google Scholar 

  26. Ulku CH (2017) Inlay butterfly cartilage tympanoplasty: anatomic and functional results. Indian J Otolaryngol Head Neck Surg. https://doi.org/10.1007/s12070-017-1097-2

    Article  PubMed  PubMed Central  Google Scholar 

  27. Tos M (1972) Tympanoplasty and age. Arch Otolaryngol 96(6):493–498

    Article  CAS  Google Scholar 

  28. Kessler A, Potsic WP, Marsh RR (1994) Type 1 tympanoplasty in children. Arch Otolaryngol Head Neck Surg 120(5):487–490

    Article  CAS  Google Scholar 

  29. Rozendorn N, Wolf M, Yakirevich A, Shapira Y, Carmel E (2016) Myringo-plasty in children. Int J Pediatr Otorhinolaryngol 90:245–250

    Article  Google Scholar 

Download references

Funding

This study was not financially supported from external sources.

Author information

Authors and Affiliations

  1. Sushrut ENT Hospital and Dr. Khan’s ENT Research Center, Talegaon Dabhade, India

    Sapna R. Parab, Mubarak M. Khan & Asiya Zaidi

Authors
  1. Sapna R. Parab
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mubarak M. Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Asiya Zaidi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sapna R. Parab.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional Ethics Committee has approved the study.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary material 1 (WMV 15225 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Parab, S.R., Khan, M.M. & Zaidi, A. Endoscopic Cartilage Butterfly Tympanoplasty: A Two-Handed Technique with Endoscope Holder. Indian J Otolaryngol Head Neck Surg 74 (Suppl 1), 100–105 (2022). https://doi.org/10.1007/s12070-020-01875-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12070-020-01875-0

Keywords

Search

Navigation