Abstract
Objective
Demonstrate feasibility of performing endoscopic transcanal type 1 tympanoplasty in total and subtotal perforations, using an underlay technique that minimizes the risk of anterior medialization of the graft. Compare audiometric and clinical outcomes of this technique with our series of endoscopic tympanoplasty with classical underlay grafts, and with previously reported outcomes of microscopic post-auricular lateral graft tympanoplasty and other transcanal techniques.
Methods
We describe a surgical technique using an L-shaped cartilage and its perichondrium, with exclusive transcanal endoscopic approach. A retrospective review of patients undergoing this technique at the Centenario University Hospital of Rosario, Argentina between January 2017 and December 2019 was performed, and it was compared with a group of patients who underwent endoscopic tympanoplasty with classical underlay technique in a previous period of time. Patients with smaller perforations and other middle ear pathologies that required other techniques were not included in this study. Minimum follow up was 6 months. The main outcome measures were membrane closure rates and hearing results.
Results
73 patients with total or subtotal perforations undergoing endoscopic transcanal tympanoplasty between 2015 and 2019 were included. The group of patients that underwent the technique described showed no anterior medialization of the graft, and better graft take rates. The hearing outcomes were similar in all successful graft patients, with postoperative average air–bone gap of 10db (+ – 10 dB).
Conclusion
Transcanal endoscopic tympanoplasty with the technique described is an excellent option for closure of total and subtotal tympanic perforations. The rate of perforation closure is better than endoscopic tympanoplasty with classical underlay graft with similar audiometric outcome.
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All procedures performed in this study involving human participants were in accordance with the regional ethical standards (Comité de Ética en Investigación Hospital Provincial del Centenario; Comité de Bioética de la Provincia de Santa Fé), the National Research Comitee and with the 1964 Helsinki Declaration with its later amendments.
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Linares Casas, A., Ruiz, R. & De Pauli, D. Endoscopic type 1 tympanoplasty; a composite graft technique for subtotal and total perforations. Eur Arch Otorhinolaryngol 279, 181–186 (2022). https://doi.org/10.1007/s00405-021-06668-x
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DOI: https://doi.org/10.1007/s00405-021-06668-x