Comparison of Endoscopic Tympanoplasty to Microscopic Tympanoplasty

Abstract

Objectives: This study aimed to compare the outcome of endoscopic and microscopic tympanoplasty.

Methods: This was a retrospective comparative study of 73 patients (35 males and 38 females) who underwent type I tympanoplasty at Samsung Medical Center from April to December 2014. The subjects were classified into two groups; endoscopic tympanoplasty (ET, n=25), microscopic tympanoplasty (MT, n=48). Demographic data, perforation size of tympanic membrane at preoperative state, pure tone audiometric results preoperatively and 3 months postoperatively, operation time, sequential postoperative pain scale (NRS-11), and graft success rate were evaluated.

Results: The perforation size of the tympanic membrane in ET and MT group was 25.3%±11.7% and 20.1%±11.9%, respectively (P=0.074). Mean operation time of MT (88.9±28.5 minutes) was longer than that of the ET (68.2±22.1 minutes) with a statistical significance (P=0.002). External auditory canal (EAC) width was shorter in the ET group than in the MT group (P=0.011). However, EAC widening was not necessary in the ET group and was performed in 33.3% of patients in the MT group. Graft success rate in the ET and MT group were 100% and 95.8%, respectively; the values were not significantly different (P=0.304). Pre- and postoperative audiometric results including bone and air conduction thresholds and air-bone gap were not significantly different between the groups. In all groups, the postoperative air-bone gap was significantly improved compared to the preoperative air-bone gap. Immediate postoperative pain was similar between the groups. However, pain of 1 day after surgery was significantly less in the ET group.

Conclusion: With endoscopic system, minimal invasive tympanoplasty can be possible with similar graft success rate and less pain.

Keywords: Endoscopy; Minimally Invasive Surgical Procedures; Pain; Tympanoplasty.

Fig. 1.

Details of tympanoplasty. (A) Postauricular incision for microscopic postauricular tympanoplasty. (B) Microscopic view of operation field of tympanoplasty. (C) Endoscopic view of middle ear cavity during endoscopic tympanoplasty. (D) View of transcanal incision (white arrow heads) approach in endoscopic tympanoplasty.

Fig. 2.

Comparison of pain scales between the endoscopic and microscopic tympanoplasty group at immediate, 3 to 6 hours, and 1 day after surgery. VAS, visual analogue scale.

Fig. 3.

Comparison of 4.0 kHz bone conduction between the endoscopic and microscopic tympanoplasty group. Pre- and postoperative bone conduction was not significantly changed in the endoscopic tympanoplasty group, but bone conduction hearing threshold was significantly elevated after surgery in the microscopic tympanoplasty group.