Comparison of endoscopic and microscopic tympanoplasty in patients with chronic otitis media

Abstract

Background To compare the results between type I tympanoplasty performed with transcanal endoscopic ear surgery (TEES) and microscopic ear surgery (MES) for treatment of chronic otitis media in a homogenous group of patients. Methods A retrospective study was performed in our department between January 2011 and January 2016 to review primary type I tympanoplasty cases with a subtotal perforation, an intact ossicular chain, a dry ear for at least 1 month, normal middle ear mucosa, and a follow-up period of at least 6 months post surgery. The adoption of TEES or MES was divided temporally (before and since 2013). TEES was undertaken in 224 patients (224 ears) and MES in 121 patients (121 ears). Results The successful graft take rate was 94.64% (212/224) in the TEES group and 90.91% (110/121) in the MES group (P = 0.239). The improvements in the air conduction levels between the 2 groups were not statistically different at 1, 3, or 6 (> 6) months (P > 0.05) after surgery. The improvements in the air–bone gaps were not significantly different between the 2 groups (P > 0.05). The average hearing gains in the TEES group 6 (and > 6) months post surgery were 11.85 ± 5.47 dB, which was better than 10.48 ± 5.18 dB in the MES group (P = 0.031). The use of medical resources was lower in the TEES group than in the MES group regarding the average operating time (49.22 ± 8.24 min vs 81.22 ± 14.73 min, respectively; P < 0.0001). Patients receiving MES had a significant higher incidence of the wound problems (ear pain, numbness around the ears, and wet ear; P < 0.05). Conclusion TEES for type I tympanoplasty seems to achieve a shorter operative time and ideal tympanic membrane healing rate and hearing results in patients with chronic otitis media.

Endoscopic Versus Microscopic Type‐1 Tympanoplasty: A Meta‐Analysis of Randomized Trials

“…Corresponding with previous studies, our metaanalysis found ET to have a comparable post-operative ABG closure to MT (MD 0.57 dB; 95% CI, À1.23 to 2.36; p = 0.54; I 2 = 78%). 2,8,9,30,31 Additionally, our study supports the findings of a previous systematic review by Manna et al 10 by demonstrating that ET has a significantly shorter operative time than MT (MD, À24.73 min; 95% CI, À38.56 to À10.89; p = 0.0005; I 2 = 98%) reducing patient exposure to general anaesthesia. Although substantial heterogeneity in reporting prevented metaanalysis of pain scores and complication rates, in general post-operative pain and complications were more common in the MT cohort in our study.…”

“…While TM closure is the primary surgical goal of tympanoplasty, approaches demonstrating superior improvements in hearing are more favourable to surgeons and patients alike. Corresponding with previous studies, our meta‐analysis found ET to have a comparable post‐operative ABG closure to MT (MD 0.57 dB; 95% CI, −1.23 to 2.36; p = 0.54; I 2 = 78%) 2,8,9,30,31 . Additionally, our study supports the findings of a previous systematic review by Manna et al 10 by demonstrating that ET has a significantly shorter operative time than MT (MD, −24.73 min; 95% CI, −38.56 to −10.89; p = 0.0005; I 2 = 98%) reducing patient exposure to general anaesthesia.…”

Postoperative Outcomes After Tympanoplasty for Active Versus Inactive Otitis Media Patients With Tympanic Membrane Perforation: A Systematic Review and Meta-Analysis

“…in which required data were extracted from the six studies (11,(18)(19)(20)(21)(22), and a simple average is obtained.…”

“…Twenty studies (60.6%) were undertaken in India, three studies (9.1%) in China, two studies (6.1%) each in Thailand and Bangladesh, and one study (3.0%) each in Korea, Nepal, Iraq, Italy, Egypt, and Pakistan. In terms of study design, 13 studies (11,19,20,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) were randomized and 20 (7)(8)(9)(10)12,13,18,21,22,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) were nonrandomized. The inclusion and exclusion criteria of all studies are summarized in Supplementary Content 3, http://links.…”

“…Patient ages ranged from 15 to 60 years old. 23 studies recruited patients with dry ear status (11,(18)(19)(20)(21)(22)(24)(25)(26)(27)(28)(29)(31)(32)(33)35,36,(38)(39)(40)(42)(43)(44), three studies with wet ear status (30,34,37), and 7 studies with both dry and wet ear status (7)(8)(9)(10)12,13,41). Some studies only included microscopic myringoplasty (7-10, 12,13,18-21,24,26,31-33,35,37,40-42), some only endoscopic myringoplasty (27,28,30,34,38,44) and some included both types (11,19,20,(24)(25)(26)(27)(28)(29)…”