Endoscopic ear surgery in the treatment of chronic otitis media with atelectasis

Abstract

Purpose: Atelectasis otitis media (AtOM) is a chronic condition where the tympanic membrane (TM) becomes retracted towards the middle ear and the ossicular chain. Surgical treatment for this condition could be indicated based on stage of atelectasis, patient's clinical condition and hearing loss. Over the years, AtOM has been treated with various types of tympanoplasty under microscopic view. The aim of this study is to present the results of endoscopic ear surgery in AtOM.

Methods: Forty-five patients who underwent endoscopic trans-canal tympanoplasty were included in the study. Preoperative features, intraoperative findings and postoperative outcomes were collected.

Results: Preoperatively, none of the study's patients were classified with a Sadè Grade I, whereas grades II, III and IV were 3 (6.6%), 23 (32.1%) and 19 (67.8%) respectively. The 3 patients with Sadè grade II showed a conductive hearing loss higher than 20 dB and a continuous ear fullness, therefore they were surgically treated. The postoperative graft success rate was estimated at 95.5%. During follow-up, 2 patients showed a TM perforation (at 6 and 12 months after surgery) whereas 1 patient experienced a recurrence of atelectasis in the TM (16 months after surgery). The overall success rate at the final follow-up was calculated at 88.8%. The average preoperative air-conduction threshold was 51.1 ± 21.5, which reduced to 34.6 ± 22.1 (p = 0.04) at follow-up. The preoperative air-bone gap decreased from 28 ± 7.2 to 11.8 ± 10 (p = 0.002) after surgery.

Conclusion: Atelectasis otitis media might be suitable for exclusive endoscopic surgical treatment, as it appears to exhibit a low recurrence rate and promising audiological outcomes.

Keywords: Atelectasis otitis media; Endoscopic ear surgery; Middle ear endoscopy; Tympanic membrane retraction.

Fig. 1

Endoscopic tympanoplasty for a grade III tympanic membrane retraction (Sadè classification). A The tympanic membrane is retracted and adherent to the incudo-stapedial joint. B Elevation of the tympano-meatal flap with the atelectasis tympanic membrane adhered to the ossicular chain. C The adhered tympanic membrane has been elevated, revealing the intact incudo-stapedial joint. The incus is non-eroded, and the ossicular chain remains intact. D Small atticotomy performed to explore the epitympanic region and open the tympanic isthmus. E Tympanic membrane graft using tragus cartilage + temporalis fascia in an underlay technique. F Final view of the reconstructed tympanic membrane. i-s incudo-stapedial joint, a atticotomy, c cartilage, t-f temporalis fascia

Fig. 2

Endoscopic tympanoplasty for a grade IV tympanic membrane retraction (Sadè classification). A The tympanic membrane retracted and adherent to the promontory and stapes superstructure. B elevation of the tympano-meatal flap with atelectasis tympanic membrane tissue adhered to the stapes and promontory, eroded incudo-stapedial joint. C Removal of adhesion tissue around the stapes. D Atticotomy performed to explore the epitympanic region and remove tissue around the stapes and promontory. E Further atticotomy performed, removal of eroded incus, and all adhesive tissue. F Tympanic membrane graft using tragus cartilage + perichondrium. s stapes, p promontory, i incus, fn facial nerve, c cartilage

Fig. 3

Endoscopic tympanoplasty. A Atticotomy performed, eroded incus removed. A blocked tympanic isthmus is evidenced. B Atticotomy performed and incus removed. A fold blocking the mesotympanic ventilation route is identified

Fig. 4

Ossicular chain reconstruction using PORP. Ossiculoplasty with PORP in secondary planned surgery. The patient previously underwent tympanoplasty for chronic otitis media with atelectasis, during which the eroded incus was removed. Stapes superstructures were intact, and the footplate was present and mobile. The prosthesis is first placed with the hollow portion on the stapes head and then positioned under the TM in the correct position