Transcanal Endoscopic Tympanoplasty: Our Experience at a Tertiary Care Centre

Abstract

Transcanal Myringoplasty can be performed with both microscope and endoscopes. Advancement in endoscopes has started the new era of minimal invasive surgery in otology practice. Endoscopic approach offers improved visualization with wider field of view, easy access to the hidden recesses of the middle ear, avoidance of a postauricular incision and less bony drilling. To report our experience with transcanal endoscopic tympanoplasty for tubotympanic type of COM and to evaluate its outcome in terms of morphological and functional success. Prospective study, conducted during September 2017 to August 2019, including 60 patients of tubotympanic type of COM. All patients underwent transcanal endoscopic type 1 tympanoplasty. Postoperative results i.e. graft uptake (morphological success) and hearing improvement (functional success) were evaluated at 6 months. The graft take up rate was 93.33%. Preoperatively mean AB gap was 23.15 ± 7.23 dB which was reduced to 11.68 ± 4.65 dB at 6 month postoperative follow up. The mean gain in AC threshold and AB gap was 15.43 ± 4.37 dB and 11.46 ± 1.13 dB respectively. Improvement in both AC threshold and AB gap was statistically significant (p < 0.0001). No major surgical or thermal injury related complications were observed. Although both microscopic and endoscopic techniques have their advantages and disadvantages, endoscopic technique can effectively replace traditional microscopic techniques in management of COM with satisfactory outcomes. We infer that EES offers less operative time, less postoperative pain, least complications and less hospital stay thus helping to reduce the physical and psychological burden placed on patients.

Keywords: Endoscopic; Functional success; Morphological success; Transcanal; Tympanoplasty.

Fig. 1

a Showing large sized central perforation in Tympanic Membrane (Left ear) b Showing moderate sized perforation with tympanoscleotic patches (anterosuperiorly and posterosuperiorly)

Fig. 2

a Supraauricular incision for harvesting temporalis muscle fascia graft (Right Ear) b Endoscopic tympanoplasty step – middle ear view after elevation of tympanomeatal flap c After placement of temporalis fascia graft by underlay technique

Fig. 3

a and b Showing postoperative (6^th month) complete healing of tympanic membrane perforation. c Showing pin point residual perforation in tympanic membrane (Anteroinferior quadrant—Arrow Head)