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Mokhatrish M. Auricular Protrusion After the Postauricular Approach: A Review of the Current Literature. Cureus 2023; 15:e46509. [PMID: 37808593 PMCID: PMC10551775 DOI: 10.7759/cureus.46509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 10/10/2023] Open
Abstract
The postauricular approach is a widely adopted surgical technique for the ear due to its unique access to the middle ear, mastoid, and other internal structures, while adeptly concealing the surgical incision for aesthetic superiority. Despite its advantages, concerns have emerged regarding the potential for auricular protrusion following the procedure. While the exact mechanisms underlying this phenomenon remain under debate, it is worth noting that comprehensive literature on this topic is scant. Nevertheless, available studies predominantly indicate no association between the postauricular approach and lasting auricular protrusion. In the few reports that do note its occurrence, the protrusion appears transient, resolving over time. These findings suggest that surgeons should continue using the postauricular approach without concerns regarding auricular protrusion. Nonetheless, it is recommended to take all precautionary measures, including appropriate patient selection, engagement of an experienced surgeon, and meticulous postoperative dressing.
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Affiliation(s)
- Mohammad Mokhatrish
- Depratment of Surgery, Prince Sattam bin Abdulaziz University, Al-Kharj, SAU
- Department of Otorhinolaryngology and Head and Neck Surgery, Prince Sattam bin Abdulaziz University, Al-Kharj, SAU
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Kawale M, Landge S, Garg D, Kanani K. Endoscopic Versus Microscopic Type 1 Tympanoplasty (Myringoplasty) in a Rural Tertiary Care Hospital in India: A Retrospective Comparative Study. Cureus 2023; 15:e36109. [PMID: 37065312 PMCID: PMC10101192 DOI: 10.7759/cureus.36109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/13/2023] [Indexed: 03/15/2023] Open
Abstract
Background Chronic suppurative otitis media (CSOM) is described as middle ear cleft inflammation that results in long-term alterations to the tympanic membrane and/or the middle ear structures. In cases of CSOM, type 1 tympanoplasty, also known as myringoplasty, is a successful procedure for repairing the tympanic membrane and can even help restore hearing loss. This study aims to compare functional and clinical outcomes of type 1 tympanoplasty performed using transcanal endoscopic ear surgery (TEES) versus those performed via microscopic ear surgery (MES) for perforation in the tympanic membrane in the safe type of CSOM. Methodology Between January 2018 and January 2022, a retrospective analysis of 100 patients (47 men and 53 women) operated for the safe type of CSOM with a perforated tympanic membrane was conducted in our department. Based on the surgical methods, cases were randomly divided into two groups. There were 50 people in group 1 who underwent endoscopic tympanoplasty and 50 in group 2 who underwent microscopic tympanoplasty. The following factors were assessed: patient demographics; tympanic membrane perforation size at the time of surgery; operating room time; hearing outcomes, that is, closure of air-bone gap (ABG); graft uptake success rate; postoperative hospital stay; and medical resource usage. Patients were followed up for 12 weeks. Results Both groups shared similar epidemiological profiles, preoperative hearing status, and perforation sizes. In both groups, the rate of graft uptake was comparable. The average ABG closure was also quite comparable. In the case of endoscopic surgeries, the mean operative time was shorter; which was statistically significant, and complications were significantly lower in group 1. Conclusions Compared to its microscopic counterpart, endoscopic tympanoplasty has a similar graft uptake success rate and a comparable hearing outcome; however, it requires less operative time and hospital stay, has early recovery, and makes lesser use of medical resources, and it is cosmetically better.
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Tu LJ, Fina M, Golub JS, Kazahaya K, Quesnel AM, Tawfik KO, Cohen MS. Current Trends in Endoscopic Ear Surgery. OTOLOGY & NEUROTOLOGY OPEN 2022; 2:e023. [PMID: 38516579 PMCID: PMC10950159 DOI: 10.1097/ono.0000000000000023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/21/2022] [Indexed: 03/23/2024]
Affiliation(s)
- Leona J. Tu
- Drexel University College of Medicine, Philadelphia, PA
| | - Manuela Fina
- Department of Otolaryngology—Head and Neck Surgery, University of Minnesota, Minneapolis, MN
| | - Justin S. Golub
- Department of Otolaryngology—Head and Neck Surgery, Valegos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Ken Kazahaya
- Division of Pediatric Otolaryngology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Alicia M. Quesnel
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Kareem O. Tawfik
- Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Michael S. Cohen
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
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Kanotra S, Purbi S, Bashir S, Sharma P. Endoscopic Treatment of Otitis Media with Effusion. Indian J Otolaryngol Head Neck Surg 2022; 74:4356-4359. [PMID: 36742874 PMCID: PMC9895635 DOI: 10.1007/s12070-021-03012-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/28/2021] [Indexed: 02/07/2023] Open
Abstract
Myringotomy with grommet insertion is considered the standard of care for patients with unresolved otitis media with effusion and is traditionally performed under the operating microscope. The introduction of endoscopic ear surgery has provided otologists a tool for minimally invasive ear surgery with a panoramic view. We have described the use of endoscope for myringotomy and grommet insertion. The technique was found to be safe and effective and has the added advantage of being an excellent tool for teaching. The advantages and disadvantages of this technique vis a vis the traditional otomicroscopic technique have been discussed.
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Affiliation(s)
- Sonika Kanotra
- Department of E.N.T., Head and Neck Surgery, Government Medical College, Jammu, 180001 India
| | - Shweta Purbi
- Department of E.N.T., Head and Neck Surgery, Government Medical College, Jammu, 180001 India
| | - Seerat Bashir
- Department of E.N.T., Head and Neck Surgery, Government Medical College, Jammu, 180001 India
| | - Preeti Sharma
- Department of E.N.T., Head and Neck Surgery, Government Medical College, Jammu, 180001 India
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Changing Scenario in Tympanoplasty: Endoscopic Versus Microscopic Approach. Indian J Otolaryngol Head Neck Surg 2022; 74:234-240. [PMID: 36032832 PMCID: PMC9411308 DOI: 10.1007/s12070-020-02030-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022] Open
Abstract
Tympanoplasty is the most common surgery performed for Chronic Otitis Media. Here we have compared the minimally invasive endoscopic tympanoplasty with the conventional microscopic tympanoplasty. It's a comparative prospective study, involving cases of Chronic otitis media with dry perforation analysed from January 2009 to October 2019. Equally 312 patients were divided into two groups, 156 in each group and subjected for Endoscopic and Microscopic Tympanoplasty. Various parameters were studied. Graft success rate of 98.08% and 93.58% in group A and B respectively were comparable, hearing improvement in both groups was not statistically significant with p-value > 0.05, whereas the postoperative hearing improved significantly to preoperative in both groups. Endoscopic and Microscopic tympanoplasty has similar outcomes, in terms of graft success rate, hearing and duration of surgery. Cosmetic results were better in Endoscopic group whereas canalplasty rates were evident in Microscopic group.
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Our Experience with Two Handed Endoscopic Tympanoplasty. Indian J Otolaryngol Head Neck Surg 2022; 74:1-8. [PMID: 36032830 PMCID: PMC9411400 DOI: 10.1007/s12070-019-01749-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022] Open
Abstract
Endoscopic tympanoplasty is a minimally invasive procedure and may be an alternative to conventional microscopic tympanoplasty with less operative time, producing similar graft uptake. Endoscopic tympanoplasty has a major disadvantage of single handedness which is overcome by a novel concept of "Two-handed technique" using Khan's Justtach (endoholder). The aim was to study the outcomes of two handed endoscopic tympanoplasty in terms of graft uptake and hearing outcome. Two handed endoscopic tympanoplasty was performed in 20 patients with chronic suppurative otitis media between April 2018-April 2019, in the Department of Otorhinolaryngology, M.G.M. Medical college and MYH hospital, Indore. Tragal cartilage graft via palisading supported with perichondrium was used. Postoperative follow up was done at 3rd month's period, graft status and hearing evaluation was done using Pure tone audiometry. Graft uptake was intact in 19 (95%) out of 20 patients and infection and failure in 1 (5%) case, average preoperative A-B gap was 15-25 dB loss (minimal) in 1 (5%) patient, 3 (15%) patients had 25-40 dB loss (mild) and 16 (80%) patients had 40-55 dB loss (moderate) hearing loss. The post-operative improvement was evaluated in which 6 (30%) patient had 15-25 dB loss (minimal), 12 (60%) patients had 25-40 dB loss (mild), and 2 (10%) patients had 40-55 dB (moderate) conductive hearing loss. We used Wilcoxon Signed Ranks Test for audiological evaluation with a 'p value' of 0.000 making the hearing improvement significant. "Two handed endoscopic tympanoplasty" is an emerging technique which can overcome almost all the major issues related with single handed technique with high degree graft uptake and good hearing outcomes. Endoscope holder is a valuable adjunct to conventional endoscopic surgery.
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Review of Transcanal Endoscopic Ear Surgery (TEES) and Bioengineering for Pediatric Otologic Surgery. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00417-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Dongol K, Shadiyah H, Gyawali BR, Rayamajhi P, Pradhananga RB. External Auditory Canal Cholesteatoma: Clinical and Radiological Features. Int Arch Otorhinolaryngol 2021; 26:e213-e218. [PMID: 35602283 PMCID: PMC9122763 DOI: 10.1055/s-0041-1726047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 12/12/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction
External auditory canal cholesteatoma (EACC) is often misdiagnosed.
Objectives
To outline the clinical presentation of EACC, and to describe its radiological findings on high-resolution computed tomography (HRCT) of the temporal bone.
Methods
The clinical records of all patients diagnosed with EACC from April 2017 to March 2020 in a tertiary care center were retrospectively reviewed. The clinical presentation, the findings on the HRCT of the temporal bone, and the treatment provided were analyzed.
Results
A total of 9 patients, 7 males and 2 females, with a mean age of 30 years, were diagnosed with primary EACC. Six patients presented with otorrhoea, three, with otalgia, three. with hearing loss, and one with facial palsy. Some patients had multiple symptoms. The most common findings on otomicroscopy were destruction of the posterior and inferior canal walls, with cholesteatoma and intact tympanic membrane (six patients). Two patients had aural polyp, and one had a narrow ear canal due to sagging of the posterior canal wall. On HRCT, all nine patients showed soft-tissue density in the external auditory canal with erosion of the canal wall. The disease extended to the mastoid in eight cases, and to the cavity of the middle ear in one. There were three cases of dehiscence of the facial canal. Dehiscence of the dural and sinus plates was observed in two cases each. Eight patients underwent mastoidectomy, and one underwent debridement with canalplasty.
Conclusion
Review of the clinical and radiological findings is essential to reduce the rate of misdiagnosis.
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Affiliation(s)
- Kripa Dongol
- Department of Otorhinolaryngology, Institute of Medicine, Tribhuvan University Kathmandu, Nepal
| | - Hena Shadiyah
- Department of Otorhinolaryngology, Institute of Medicine, Tribhuvan University Kathmandu, Nepal
| | - Bigyan Raj Gyawali
- Department of Otorhinolaryngology, Institute of Medicine, Tribhuvan University Kathmandu, Nepal
| | - Pabina Rayamajhi
- Department of Otorhinolaryngology, Institute of Medicine, Tribhuvan University Kathmandu, Nepal
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Preyer S. [Incision-suture times in endoscopic ear surgery]. HNO 2021; 69:811-816. [PMID: 34125238 PMCID: PMC8476474 DOI: 10.1007/s00106-021-01066-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2021] [Indexed: 11/29/2022]
Abstract
Hintergrund Endoskopische Ohrchirurgie („endoscopic ear surgery“, EES) wird international immer häufiger anstelle der mikroskopischen Ohrchirurgie („microscopic ear surgery“, MES) eingesetzt, hat sich in Deutschland aber als Routineverfahren noch nicht etabliert. Fragestellung Untersucht wurden die Schnitt-Naht-Zeiten bei der EES und die Praktikabilität der Methode im deutschen Klinik-Setting. Material und Methoden In einer retrospektiven Studie wurden 60 konsekutive mikroskopisch operierte Patienten (MES) von 2015 mit 60 konsekutiven endoskopisch operierten Patienten aus dem Jahr 2018 verglichen. Verglichen wurden Hörergebnisse, Trommelfellbefund und Schnitt-Naht-Zeiten nach 3 Wochen. Ergebnisse Bei endoskopisch geführten Ohroperationen war der Zugang meistens transmeatal und musste seltener als bei mikroskopisch durchgeführten Operationen die Gehörgangsvorderwand zurückgeschliffen werden. Die Operationszeiten unterschieden sich in den 2 Gruppen statistisch nicht signifikant. Ein Trommelfellverschluss gelang bei 57/60 Patienten in der mikroskopischen Gruppe und bei 59/60 in der endoskopischen Gruppe. Eine Hörverbesserung wurde in beiden Gruppen erreicht. Die Hörverbesserung war in den 2 Gruppen statistisch signifikant nicht unterschiedlich. Schlussfolgerungen Endoskopische Ohrchirurgie ist eine zeitökonomische und minimal-invasive Methode und stellt bei vergleichbaren Ergebnissen eine praktikable Alternative zur mikroskopischen Ohrchirurgie dar.
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Affiliation(s)
- S Preyer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie und plastische Gesichtschirurgie, ViDia-Kliniken Karlsruhe, Steinhäuserstraße 18, 76133, Karlsruhe, Deutschland.
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Abstract
INTRODUCTION Endoscopic stapes surgery is a technically demanding procedure that is increasing in popularity. Surgical outcomes and complication rates have been demonstrated to be comparable to traditional microscopic techniques. The surgical outcomes for patients undergoing stapes surgery performed by the Sydney Endoscopic Ear Surgery Research Group are presented. STUDY DESIGN Retrospective review from prospectively gathered database. SETTING Tertiary referral centers. PATIENTS A retrospective case review of patients undergoing endoscopic stapes surgery performed by four surgeons between February 2015 and July 2019 was carried out. Sixty nine patients were identified, and assessed for demographics, functional results, and postoperative complications. INTERVENTION Endoscopic stapedotomy. MAIN OUTCOME MEASURE Postoperative hearing results. RESULTS Sixty eight of 69 patients (98.6%) achieved an air-bone gap (ABG) closure of less than 20 dB. Sixty of 69 patients (87%) achieved and ABG closure of less than 10 dB. The average improvement of the ABG over four frequencies achieved was 26.5 dB (range, 0-61). Postoperative complications were infrequent and self-limiting. Six patients experienced dysgeusia without obvious chorda tympani injury, four patients developed short lived vertigo, and two patients experienced tinnitus. CONCLUSIONS Endoscopically assisted stapes surgery represents a safe alternative to traditional microscopic techniques, with similar morbidity and audiological outcomes.
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Kim DJ, Lee HM, Choi SW, Oh SJ, Kong SK, Lee IW. Comparative study of endoscopic and microscopic tympanoplasty performed by a single experienced surgeon. Am J Otolaryngol 2021; 42:102788. [PMID: 33171411 DOI: 10.1016/j.amjoto.2020.102788] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/13/2020] [Accepted: 10/17/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE The use of endoscopes in otologic procedures has been increasing worldwide. This study aimed to compare the efficacy of microscopic tympanoplasty (MT) and endoscopic tympanoplasty (ET) for tympanic membrane and middle ear surgery. MATERIALS AND METHODS We retrospectively analyzed 81 patients who underwent MT (n = 44) and ET (n = 37) for chronic otitis media with tympanic membrane perforation performed by a single surgeon between January 2013 and September 2019. The hearing outcomes, graft success rate, complications, operation time and hospital stay, and cost-effectiveness were recorded and compared between groups. Hearing outcomes were determined by pure tone audiometry. Cost-effectiveness was determined by the operation cost and total cost. RESULTS There was no significant difference between the MT and ET groups regarding demographic characteristics, with the exception of the male:female ratio. There was no significant difference in the pre- and postoperative air conduction, bone conduction thresholds, and air-bone gap values between the two groups, but a significant audiologic improvement was observed in both groups (p < 0.05). In terms of recurrence of tympanic membrane perforation, postoperative otorrhea, and discomfort symptoms, there was no significant difference between groups (p > 0.05). The operation time and hospital stay were shorter in the ET group than in the MT group (p < 0.05). There were no significant differences in operation cost between the two groups (p > 0.05), but the total cost was significantly lower in the ET group than the MT group (p < 0.05). CONCLUSION ET is as safe and medically efficacious as conventional MT, shortens the operation time and hospital stay, and is cost-effective.
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Affiliation(s)
- Dong Jo Kim
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hyun Min Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sung-Won Choi
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Se-Joon Oh
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Soo-Keun Kong
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Il-Woo Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
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Endoscopic transcanal excision of a rare huge middle ear capillary hemangioma – Case report and literature review. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2020.100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Zhang J, Hu S. Comparison of endoscopic tympanoplasty to microscopic tympanoplasty in anterior tympanic membrane perforation. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2020. [DOI: 10.1016/j.lers.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Shakya D, Nepal A. Total Endoscopic Perichondrium Reinforced Cartilage Myringoplasty for Anterior Perforation. EAR, NOSE & THROAT JOURNAL 2020; 101:158-164. [PMID: 32776835 DOI: 10.1177/0145561320946908] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To investigate the outcomes of graft uptake and hearing results in the repair of anterior perforation via a total endoscopic transcanal approach using a single or double perichondrium reinforced cartilage underlay technique. STUDY DESIGN Retrospective study. SETTING Tertiary referral hospital. MATERIALS AND METHODS We analyzed 65 patients who underwent surgery for anterior perforation. All surgeries were done via an endoscopic transcanal approach using tragal cartilage as graft, underlay technique reinforced with single or double perichondrium. Two groups were created in which group A had single perichondrium reinforcement and group B had double perichondrium. Graft uptake and hearing outcomes were evaluated between the two groups. RESULTS During the study period, 65 patients were included, of which 3 were lost to follow-up, and thus, only 62 patients were assessed. As for the surgical outcome, graft uptake was observed in 95.2% (n = 59) of patients, 6 months after the intervention. Graft uptake was not statistically significantly different between groups A and B and was 95% in both. There was a statistically significant improvement in hearing across the series overall, with no significant differences seen between group A and group B. CONCLUSIONS The endoscopic approach for myringoplasty offers superior visualization, especially for anterior perforation avoiding postaural approach and canaloplasty. Endoscopic single or double perichondrium reinforced cartilage underlay technique is a reliable method for repair of anterior perforation. There is no difference in using single or double perichondrium reinforcement. Thus, we recommend using single or double perichondrium reinforcement depending on the need during the surgery.
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Affiliation(s)
- Dipesh Shakya
- Department of Otorhinolaryngology, Civil Service Hospital, Minbhawan, Kathmandu, Nepal
| | - Ajit Nepal
- Department of Otorhinolaryngology, Patan Academy of Health Sciences, School of Medicine, Lagankhel, Lalitpur, Nepal
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Poletti AM, Solimeno LS, Cugini G, Miceli S, Colombo G. Microendoscopic Surgery of Middle Ear and Petrous Bone: Benefits Analysis. EAR, NOSE & THROAT JOURNAL 2020; 100:943S-948S. [PMID: 32511009 DOI: 10.1177/0145561320930017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Endoscopy has become routinely used in middle ear surgery. The aim of this study is to analyze where this tool may complement the traditional microscopic approach. This is a retrospective study done in single tertiary hospital. METHODS We reviewed 342 middle ear/petrous bone surgical procedures performed between 2005 and 2015. Only cases in which both microscopic and endoscope-assisted techniques were used have been included. Sixty-six patients received this double-technique surgery: 51 (77.2%) had middle ear/mastoid and petrous bone cholesteatomas (46 middle ear and mastoid and 5 acquired/congenital petrous bone cholesteatomas), 5 (7.5%) had glomus tympanicum tumors (GTT), 4 (6%) had an ossicular chain dislocation, 3 (4.5%) had purulent chronic otitis media, 2 (3%) had tympanosclerosis, and 1 (1.5%) had an ossicular chain malformation. RESULTS The endoscope was helpful to remove disease remnants not accessible by microscope in 41 (62%) of the cases; 37 (90%) were cholesteatomas, 3 (7%) were GTT, and only 1 (3%) was an open tympanosclerosis. In the remaining 25 (37.8%) cases, the endoscope was useful only to visualize the cavity since the microscope had already been successful in removing the entire lesion. CONCLUSIONS The endoscopy can add valuable information and support to the usual microscope approach alone. The consensus of a single best technique does not yet exist, but the physician should choose the best modality or combination of modalities in order to cure the patient and prevent any possible complications or recurrence of the pathology.
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Affiliation(s)
- Arturo Mario Poletti
- ENT Department, American Hospital Dubai, United Arab Emirates.,Otolaryngology Department, Humanitas Clinical and Research Hospital, Rozzano, Milano, Italy
| | | | - Giovanni Cugini
- Otolaryngology Department, Humanitas Clinical and Research Hospital, Rozzano, Milano, Italy
| | - Stefano Miceli
- Otolaryngology Department, Humanitas Clinical and Research Hospital, Rozzano, Milano, Italy
| | - Giovanni Colombo
- Otolaryngology Department, Humanitas Clinical and Research Hospital, Rozzano, Milano, Italy
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Parelkar K, Thorawade V, Marfatia H, Shere D. Endoscopic cartilage tympanoplasty: full thickness and partial thickness tragal graft. Braz J Otorhinolaryngol 2020; 86:308-314. [PMID: 30837190 PMCID: PMC9422511 DOI: 10.1016/j.bjorl.2018.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 11/22/2018] [Accepted: 12/11/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Cartilage is the grafting material of choice for certain disorders of the middle ear. The indications for its routine use remain controversial due to the possible detrimental effect on post-operative hearing. Objective The present study was carried out to report a personal experience with “tragal cartilage shield” tympanoplasty to compare the results, in terms of graft uptake and hearing improvement, of endoscopic cartilage shield technique using either partial thickness or full thickness tragal cartilage for type 1 tympanoplasty and to highlight the tips for single-handed endoscopic ear surgery. Methods Fifty patients with safe chronic suppurative otitis media, assisted at out-patient department from February 2014 to September 2015 were selected. They were randomly allocated into two groups, 25 patients were included in group A where a full thickness tragal cartilage was used and 25 patients included in group B where a partial thickness tragal cartilage was used. Audiometry was performed 2 months after the surgery in all cases and the patients were followed for one year. Results Out of the total of 50 patients 39 (78%) had a successful graft take up, amongst these 22 belonged to group A and 17 belonged to the group B. The hearing improvement was similar in both groups. Conclusion This study reveals that endoscopic tragal cartilage shield tympanoplasty is a reliable technique; with a high degree of graft take and good hearing results, irrespective of the thickness. Furthermore, the tragal cartilage is easily accessible, adaptable, resistant to resorption and single-handed endoscopic ear surgery is minimally invasive, sutureless and provides a panoramic view of the middle ear.
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Affiliation(s)
- Kartik Parelkar
- Grant Government Medical College & Sir J.J. Hospitals, Mumbai, India.
| | - Vandana Thorawade
- Grant Government Medical College & Sir J.J. Hospitals, Mumbai, India
| | - Hetal Marfatia
- K.E.M. Hospital, Department of ENT, Parel, Mumbai, India
| | - Devika Shere
- Rajiv Gandhi Medical College & Chhatrapati Shivaji Maharaj Hospital, Kalwa, Thane, India
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Das A, Mitra S, Ghosh D, Sengupta A. Endoscopic Versus Microscopic Management of Attic Cholesteatoma: A Randomized Controlled Trial. Laryngoscope 2019; 130:2461-2466. [DOI: 10.1002/lary.28446] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/06/2019] [Accepted: 11/11/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Arindam Das
- Institute of Post Graduate Medical Education and Research and SSKM Hospital Kolkata India
| | - Sandipta Mitra
- Institute of Post Graduate Medical Education and Research and SSKM Hospital Kolkata India
| | - Debasish Ghosh
- Institute of Post Graduate Medical Education and Research and SSKM Hospital Kolkata India
| | - Arunabha Sengupta
- Institute of Post Graduate Medical Education and Research and SSKM Hospital Kolkata India
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Abstract
OBJECTIVE The aim of this study was to examine the premise that endoscopic ear surgery (EES) is associated with a low rate of complications (intraoperative and postoperative). STUDY DESIGN Retrospective review at two institutions. SETTING Tertiary referral center. PATIENTS The study included 825 patients who underwent exclusive EES between 2008 and 2016 at the Otorhinolaryngology-Head and Neck Surgery Department of Modena University Hospital, and between 2014 and 2016 at the Otorhinolaryngology-Head and Neck Surgery Department of Verona University Hospital. INTERVENTIONS Exclusive endoscopic ear surgery between 2008 and 2016 (tympanoplasties, second look or revision tympanoplasties, myringoplasties, stapedoplasties, canalplasties, ossiculoplasties, and exploratory tympanotomies). All surgical procedures were performed by two experienced surgeons. MAIN OUTCOME MEASURE For each procedure, intraoperative, and early and delayed postoperative complications were evaluated. RESULTS The most common ear pathologies for which patients were sent for EES were cholesteatoma (33.6%), chronic otitis media (36.3%) and otosclerosis (26.8%). There was no case of major intraoperative complications such as injury to the dura or vascular structures. We observed minor intraoperative complications in 4.1% of the cases. Only 1.3% of patients experienced early postoperative complications. Delayed complications affected less than 1% of the cohort. CONCLUSIONS Data from this study confirm the safety of the endoscopic technique, with very low complication rates, indicating that EES is a reliable therapeutic option, in particular, for tympanoplasties, myringoplasties, and stapedoplasties, as well as second look procedures. We have reported our experience with EES morbidity so that it can be compared with data from other centers using the same surgical technique.
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Shakya D, Kc A, Nepal A. A Comparative Study of Endoscopic versus Microscopic Cartilage Type I Tympanoplasty. Int Arch Otorhinolaryngol 2019; 24:e80-e85. [PMID: 31892962 PMCID: PMC6828568 DOI: 10.1055/s-0039-1693139] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/21/2019] [Indexed: 11/08/2022] Open
Abstract
Introduction
The use of endoscope is rapidly increasing in otological and neuro-otological surgery in the last 2 decades. Middle ear surgeries, including tympanoplasty, have increasingly utilized endoscopes as an adjunct to or as a replacement for the operative microscope. Superior visualization and transcanal access to diseases normally managed with a transmastoid approach are touted as advantages with the endoscope.
Objectives
The present study aimed to compare the outcomes of endoscopic and microscopic cartilage tympanoplasty (Type I)
Methods
This was a retrospective comparative study of 70 patients (25 males and 45 females) who underwent type I tympanoplasty between March 2015 and April 2016. The subjects were classified into 2 groups: endoscopic tympanoplasty (ET,
n
= 35), and microscopic tympanoplasty (MT,
n
= 35). Tragal cartilage was used as a graft and technique used was cartilage shield tympanoplasty in both groups. Demographic data, perforation size of the tympanic membrane at the preoperative state, operation time, hearing outcome, and graft success rate were evaluated.
Results
The epidemiological profiles, the preoperative hearing status, and the perforation size were similar in both groups. The mean operation time of the MT group (52.63 ± 8.68 minutes) was longer than that of the ET group (48.20 ± 10.37 minutes), but the difference was not statistically significant. The graft success rates 12 weeks postoperatively were 91.42% both in the ET and MT groups, that is, 32/35; and these values were not statistically significantly different. There was a statistically significant improvement in hearing within the groups, both pre- and postoperatively, but there was no difference between the groups.
Conclusion
Endoscopic tympanoplasty is a minimally invasive surgery with similar graft success rate, comparable hearing outcomes and shorter operative time period as compared to microscopic use.
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Affiliation(s)
- Dipesh Shakya
- Department of Otorhinolaryngology, Civil Service Hospital, Kathmandu, Nepal
| | - Arun Kc
- Department of Otorhinolaryngology, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Ajit Nepal
- Department of Otorhinolaryngology, Patan Academy of Health Science, Lalitpur, Nepal
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Gülşen S, Arıcı M. Endoscopic transcanal versus conventional microscopic tympanoplasty in treatment of anterior tympanic membrane perforations. Eur Arch Otorhinolaryngol 2019; 276:3327-3333. [PMID: 31535293 DOI: 10.1007/s00405-019-05646-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/11/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the surgical outcomes of endoscopic transcanal tympanoplasty (ETT) and conventional microscopic tympanoplasty (CMT) in repairing anterior tympanic membrane perforations (ATMPs). METHODS We retrospectively analyzed the graft success rate, hearing outcomes, operative time, hospitalization period and complications in patients who underwent ETT and CMT between October 2015 and July 2018. In addition, the authors investigated whether anterior canal wall protrusion (ACWP) affects the graft success rate and operative time. RESULTS The graft success rates for ETT and CMT were 93.7% (30 out of 32 patients) and 91.4% (32 out of 35 patients), respectively (p = 0.640). There was no significant relationship between ACWP and graft success rates in either the endoscopic (p = 0.685) and microscopic (p = 0.894) group. The mean operative time was significantly shorter in the ETT group (37.2 ± 3.1 min) than in the CMT group (52.9 ± 9.2 min) (p < 0.001). Regarding operative time, there was no statistically significant difference between patients with and without ACWP (38.3 versus 36.3 min, respectively (p = 0.124)) in the ETT group. However, the mean operative time of patients with ACWP in the CMT group was significantly longer than patients without ACWP [62.3 versus 48.8 min, respectively (p < 0.001)]. CONCLUSIONS ETT offering fewer complication rates and shorter duration of surgery may serve as a reasonable alternative to CMT in repairing ATMPs, with comparable graft success rates.
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Affiliation(s)
- Secaattin Gülşen
- Department of Otorhinolaryngology, Dr Ersin Arslan Training and Research Hospital, Eyupoglu Avenue, No: 40, Hurriyet Street, Şahinbey, Gaziantep, 27000, Turkey.
| | - Mehmet Arıcı
- Department of Otorhinolaryngology, Faculty of Medicine, Adıyaman University, Adıyaman, Turkey
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Ayache S, Beltran M, Guevara N. Endoscopic classification of the external auditory canal for transcanal endoscopic ear surgery. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:247-250. [DOI: 10.1016/j.anorl.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Shakya D, Kc A, Nepal A, Tamang N. Total Endoscopic Transcanal Cartilage Myringoplasty: A Prospective Study. Int Arch Otorhinolaryngol 2019; 23:e440-e444. [PMID: 31649765 PMCID: PMC6805195 DOI: 10.1055/s-0039-1691758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/04/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction
Middle ear surgeries, including myringoplasty, have increasingly utilized endoscopes as an adjunct to or as a replacement for the operative microscope.
Objectives
The objective of the present study was to evaluate the graft uptake rate and to evaluate the hearing results.
Methods
This is a prospective study. We have analyzed 139 patients who underwent surgery for chronic otitis media (COM) of the mucosal type. All of the surgeries were performed exclusively under total endoscopic transcanal approach using tragal cartilage as graft, underlay technique. We have evaluated the postoperative graft uptake and performed a hearing evaluation at 6 weeks, at 12 weeks, and at 6 months.
Results
During the study period, 139 patients were included, out of which 13 were lost to follow-up; therefore, only 126 patients were assessed. All of the cases were performed under total endoscopic approach. As for the surgical outcome at the postoperative otoscopy, 3 cases had initial uptake at 3 months and failed later; therefore, complete closure of the perforation was observed in 97.6% (
n
= 123) of the patients 6 months after the intervention.
Four patients presented with preoperative anacusis; therefore, only 122 patients were included for hearing evaluation. The preoperative air conduction threshold (ACT) and airbone gap (ABG) were 43.34 ± 11.53 and 24.73 ± 7.89, respectively.
Postoperatively, the ACT and ABG closure were 28.73 ± 15.75 and 11.91 ± 8.41, respectively. This difference was statistically significant (
p
< 0.001).
Conclusion
The endoscopic approach for myringoplasty offers excellent visualization; avoids postaural approach, enables a faster recovery, requires less hospital stay, with excellent graft closure rate and improved functional outcomes.
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Affiliation(s)
- Dipesh Shakya
- Department of Ear Nose and Throat, Civil Service Hospital, Minbhawan Kathmandu, Kathmandu, Nepal
| | - Arun Kc
- Department of Otorhinolaryngology, Patan Academy of Health sciences, Lalitpur, Nepal
| | - Ajit Nepal
- Department of Otorhinolaryngology, Patan Academy of Health sciences, Lalitpur, Nepal
| | - Nirmala Tamang
- Department of Otorhinolaryngology, Civil Service Hospital, Kathmandu, Nepal
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Rusetsky YY, Meitel IY, Sotnikova LS, Malyavina US, Kalugina MS. [Prospects of endoscopic otosurgery in children]. Vestn Otorinolaringol 2019; 84:5-11. [PMID: 31486419 DOI: 10.17116/otorino2019840315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Active progress in otosurgery opens up new opportunities for minimally invasive surgeries and significantly improves the results of treatment, but a number of problems remain unsolved, including in children. Despite the general positive trend of using the endoscope in otosurgery, in pediatric practice the data are insufficient and extremely contradictory. Literary sources show that, with certain advantages, the existing techniques of endoscopic tympanoplasty are far from perfect and inferior in effectiveness to classical microscopic techniques, which also necessitates further research in this field.
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Affiliation(s)
- Yu Yu Rusetsky
- National medical research center for children's health of the Ministry of health of Russia, Moscow, Russia, 119991
| | - I Yu Meitel
- National medical research center for children's health of the Ministry of health of Russia, Moscow, Russia, 119991
| | - L S Sotnikova
- National medical research center for children's health of the Ministry of health of Russia, Moscow, Russia, 119991
| | - U S Malyavina
- National medical research center for children's health of the Ministry of health of Russia, Moscow, Russia, 119991
| | - M S Kalugina
- National medical research center for children's health of the Ministry of health of Russia, Moscow, Russia, 119991
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Shrestha B, Dhakal A, Kiran KCA, Shrestha K, Pradhan A. Long-term hearing results in endoscopic sandwich myringoplasty: An innovative Dhulikhel hospital technique. INDIAN JOURNAL OF OTOLOGY 2019. [DOI: 10.4103/indianjotol.indianjotol_22_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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25
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Han SY, Lee DY, Chung J, Kim YH. Comparison of endoscopic and microscopic ear surgery in pediatric patients: A meta-analysis. Laryngoscope 2018; 129:1444-1452. [PMID: 30593662 DOI: 10.1002/lary.27556] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 08/01/2018] [Accepted: 08/13/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Recently, the endoscope has been increasingly introduced for middle-ear surgery. To evaluate the postoperative outcomes of endoscopic ear surgery (EES) in pediatric patients, we did a qualitative analysis with a systematic review and quantitative analysis with meta-analysis of available literature. METHODS Studies reporting the comparative surgical outcomes of EES in pediatric patients were systematically reviewed by searching the MEDLINE, PubMed, and Embase databases from database inception through 2017. The selected articles included clinical studies conducted with at least 30 subjects and at least one postoperative parameter, including residual or recurrent cholesteatoma and graft success in tympanoplasty. Two investigators independently reviewed all studies and extracted the data using a standardized form. A meta-analysis was performed using a random-effects model and qualitative review was performed on the smaller studies. RESULTS Ten studies were identified as appropriate for quantitative meta-analysis and 19 studies for qualitative analysis. In the meta-analysis, residual or recurrence rate of cholesteatoma was significantly lower in the EES group than in the microscopic ear surgery (MES) group (odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.38-0.84, P = .005). The graft success rate of tympanoplasty was not statistically different between EES and MES groups (OR: 0.72, 95% CI: 0.41-1.26, P = .249). In the qualitative analysis, most of the studies reported similar audiological outcomes after tympanoplasty and success rate of cholesteatoma removal between the two groups. CONCLUSIONS It appears that EES reduces the risk of residual cholesteatoma in children and that the success of perforation closure is equivalent to MES. Laryngoscope, 129:1444-1452, 2019.
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Affiliation(s)
- Sang-Yoon Han
- the Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Doh Young Lee
- the Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Juyong Chung
- the Department of Otolaryngology-Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Young Ho Kim
- the Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
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A modified method of local infiltration for endoscopic stapes surgery: how I do it. Eur Arch Otorhinolaryngol 2018; 276:357-365. [PMID: 30535977 DOI: 10.1007/s00405-018-5238-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/03/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To present a modified method of local infiltration (MMLI) for endoscopic stapes surgery to reduce surgical time, bleeding and complications. MATERIALS AND METHODS This study involved 70 patients who underwent stapes surgery for otosclerosis by endoscopic and microscopic approaches. The MMLI was applied as follows: local infiltration was performed with one hand while the other hand inserted the endoscope into the ear canal to observe vasoconstriction signs on the monitor; the single site of infiltration was located at the center of the anterior conchal cartilage. Operative time, intraoperative blood loss, preservation of anatomical structures, postoperative hearing and complications were evaluated. RESULTS The MMLI allowed for quick bleeding control and a clear and dry operative field. Operative time, intraoperative blood loss and preservation of anatomical structures were significantly reduced in the endoscopic group (P < 0.00) versus the microscopic group. The scutum was removed less frequent in the endoscopic group 7.1% versus 53.6% of the microscopic group (P < 0.00). The chorda tympani was preserved in all cases but it was more manipulated in the microscopic group 39.3% versus 9.5% of the endoscopic group (P < 0.00). No complications were observed and the hearing outcomes were significantly better than the preoperative thresholds. CONCLUSIONS This is the first report on the use of a MMLI for endoscopic stapes surgery. Using this method, the surgeon performs the infiltration at one site and concurrently observes the vasoconstriction signs without the use of a microscope, frontal lamp or speculum. This method provides benefits in terms of operative time and complications.
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Novel three-dimensional image system for endoscopic ear surgery. Eur Arch Otorhinolaryngol 2018; 275:2933-2939. [DOI: 10.1007/s00405-018-5153-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/26/2018] [Indexed: 12/16/2022]
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Stapedotomy using a 4 mm endoscope: any advantage over a microscope? The Journal of Laryngology & Otology 2018; 132:807-811. [DOI: 10.1017/s0022215118001548] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectivesTo ascertain the feasibility of endoscopic (4 mm) stapedotomy, and compare intra- and post-operative variations with microscopic stapedotomies.MethodsForty otosclerosis patients were scheduled for microscopic or endoscopic stapedotomy. Intra-operative variables compared were: incision, canalplasty, canal wall curettage for ossicular assessment, chorda tympani manipulation, ability to perform stapes footplate perforation before its supra-structure removal, and operative time. Post-operative variables compared were ear pain and hearing improvement.ResultsOf the 20 microscopy patients, 4 required endaural incision and canalplasty because of canal overhangs, and 7 required canal wall curettage for ossicular assessment. None of the 20 endoscopy patients required these procedures. Chorda tympani was manipulated in 13 and 6 patients in the microscopy and endoscopy groups respectively, while the stapes footplate could be perforated in 5 and 11 patients respectively. Mean operative time was 50.25 and 76.05 minutes in the microscopy and endoscopy groups respectively. In the endoscopy group, mean air–bone gap was 37.12 and 10.73 dB pre- and post-operation respectively; in the microscopy group, these values were 35.95 and 13.81 dB.ConclusionEndoscopic stapedotomy has comparable hearing outcomes. Sinonasal endoscope serves as a better tool for: minimal incision, canalplasty avoidance, less chorda tympani mobilisation, and stapes footplate perforation ability.
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Endoscopic push-through technique compared to microscopic underlay myringoplasty in anterior tympanic membrane perforations. The Journal of Laryngology & Otology 2018; 132:509-513. [DOI: 10.1017/s0022215118000889] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackgroundMicroscopic myringoplasty is the most frequently performed procedure for repairing tympanic membrane perforations. The endoscopic transcanal approach bypasses the narrow ear canal segment and provides a wider view.MethodsAn open-label randomised clinical trial was conducted on 56 patients with small anterior tympanic membrane perforations. Perforations were repaired with an endoscopic push-through technique (n= 28) or a microscopic underlay technique (n= 28). Follow up was conducted using endoscopic examination and pure tone audiometry three months’ post-operatively.ResultsGraft success rate was 92.9 per cent in the endoscopic group versus 85.7 per cent in the microscopic group. The corresponding pre-operative mean air–bone gaps were 17.4 dB and 18.5 dB, improving to 6.1 dB and 9.3 dB post-operatively (p> 0.05). Mean air–bone gap closure was 11.4 dB in the endoscopic group and 9.2 dB in the microscopic group (p> 0.05). Mean operative time and estimated blood loss were 37.0 minutes and 29 ml in the endoscopic group, versus 107 minutes and 153 ml in the microscopic group (bothp< 0.05).ConclusionThe endoscopic push-through technique for anterior tympanic membrane perforations is as effective as microscopic underlay myringoplasty; furthermore, it is less invasive and takes less operative time.
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Daneshi A, Asghari A, Mohebbi S, Farhadi M, Farahani F, Mohseni M. Total Endoscopic Approach in Glomus Tympanicum Surgery. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2017; 29:305-311. [PMID: 29383310 PMCID: PMC5785109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Glomus tympanicum (GT) is a benign primary tumor of the middle ear. The evolution of endoscopic ear surgery has allowed for an alternative approach to managing this vascular tumor. The purpose of this study was to evaluate an endoscopic approach in GT surgery, and also to investigate its applicability and feasibility. MATERIALS AND METHODS Prospectively, 13 class I and II patients, according to the Glasscock-Jackson glomus classification, were candidates for management via a transcanal endoscopic approach. Patients were categorized into three groups according to the location of the tumor in the middle ear. Group A consisted of patients with tumors located anteriorly while occupying the Eustachian tube. Group B were patients with tumors located on the promontory with entirely visible tumor borders. Patients in Group C had tumors that occupied the entire middle ear. Under specially designed flap elevation and hemostasis, the tumors were completely removed using an endoscopic technique. RESULTS Based on the classification criteria, three patients fell into Group A (30%), six into Group B (46%), and three into Group C (23%). The principal chief complaint was pulsatile tinnitus that disappeared after surgery in most cases. Hearing status was mostly mixed hearing loss. No change was detected in bone conduction after surgery, but air conduction was improved in nine cases. No major complication or recurrence was observed over 30 months of follow up. CONCLUSION Improved exposure and access in the endoscopic transcanal approach to GT leads to safe, rapid, and reliable tumor removal, as well as allowing comfortable surgery for both the surgeon and most patients.
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Affiliation(s)
- Ahmad Daneshi
- ENT Head and Neck Research Center and Department, Iran University of Medical Science, Tehran, Iran.
| | - Alimohamad Asghari
- ENT Head and Neck Research Center and Department, Iran University of Medical Science, Tehran, Iran.
| | - Saleh Mohebbi
- Skull Base Research Center, Iran University of Medical Science, Tehran, Iran.,Corresponding Author:Department of Otolaryngology, Hazrat-e Rasool General Hospital, Niyayesh St., Satarkhan St., Tehran, Iran, Tel: +982166511011, E-mail:
| | - Mohammad Farhadi
- ENT Head and Neck Research Center and Department, Iran University of Medical Science, Tehran, Iran.
| | - Farhad Farahani
- Department of Otolaryngology, Hamedan University of Medical Science, Hamedan, Iran.
| | - Mohammad Mohseni
- ENT Head and Neck Research Center and Department, Iran University of Medical Science, Tehran, Iran.
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Kaya I, Turhal G, Ozturk A, Gode S, Bilgen C, Kirazli T. Results of endoscopic cartilage tympanoplasty procedure with limited tympanomeatal flap incision. Acta Otolaryngol 2017; 137:1174-1177. [PMID: 28741445 DOI: 10.1080/00016489.2017.1354393] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the outcomes of this minimally invasive tympanomeatal incision technique performed during endoscopic transcanal cartilage tympanoplasty. STUDY DESIGN Prospective clinical study. METHODS Eighty-seven patients (87 ears) who had TM perforation with noncomplicated COM were included. All of the patients were operated with the endoscopic transcanal cartilage tympanoplasty technique. All of the data were prospectively collected. These included demographic data, date of the surgery, preoperative and postoperative pure-tone audiometry (PTA), localization of TM perforation and graft healing success. RESULTS Mean follow-up time was 14.76 ± 4.32 months. Graft-healing rate was 100%. Mean air bone gap level improvement (dB HL) at 0.5, 1, 2 and 4 kHz were 13.87 ± 7.30 dB HL, 9.09 ± 7.59 dB HL, 9.74 ± 6.40 dB HL and 7.46 ± 6.37 dB HL, respectively. At all frequencies, there was significant difference between pre and postoperative mean air bone gap levels (p < .05). There was no significant correlation between the postoperative mean air bone gap level improvement and the localization of the perforation (p > .05). CONCLUSIONS Endoscopic ear surgery has successful surgical outcomes with low complication rates. In this study, the outcomes of limited tympanomeatal flap incision was discussed. It is suggested that this technique is reliable with good hearing results with low postoperative complications rates.
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Affiliation(s)
- Isa Kaya
- Otolaryngology Department, Ege University School of Medicine, Izmir, Turkey
| | - Goksel Turhal
- Otolaryngology Department, Selcuk State Hospital, Izmir, Turkey
| | - Arin Ozturk
- Otolaryngology Department, Ege University School of Medicine, Izmir, Turkey
| | - Sercan Gode
- Otolaryngology Department, Ege University School of Medicine, Izmir, Turkey
| | - Cem Bilgen
- Otolaryngology Department, Ege University School of Medicine, Izmir, Turkey
| | - Tayfun Kirazli
- Otolaryngology Department, Ege University School of Medicine, Izmir, Turkey
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Ultrasonic bone aspirator use in endoscopic ear surgery: feasibility and safety assessed using cadaveric temporal bones. The Journal of Laryngology & Otology 2017; 131:987-990. [DOI: 10.1017/s0022215117001955] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectives:To describe the feasibility and assess the safety of using an ultrasonic bone aspirator in endoscopic ear surgery.Methods:Five temporal bones were dissected via endoscopic ear surgery using a Sonopet ultrasonic bone aspirator. Atticoantrostomy was undertaken. Another four bones were dissected using routine endoscopic equipment and standard bone curettes in a similar manner. Feasibility and safety were assessed in terms of: dissection time, atticoantrostomy adequacy, tympanomeatal flap damage, chorda tympani nerve injury, ossicular injury, ossicular chain disruption, facial nerve exposure and dural injury.Results:The time taken to perform atticoantrostomy was significantly less with the use of the ultrasonic bone aspirator as compared to conventional bone curettes.Conclusion:The ultrasonic bone aspirator is a feasible option in endoscopic ear surgery. It enables easy bone removal, with no additional complications and greater efficacy than traditional bone curettes. It should be a part of the armamentarium for transcanal endoscopic ear surgery.
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Akyigit A, Sakallıoglu O, Karlidag T. Endoscopic tympanoplasty. J Otol 2017; 12:62-67. [PMID: 29937839 PMCID: PMC5963455 DOI: 10.1016/j.joto.2017.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 12/23/2022] Open
Abstract
Middle ear surgery is usually performed using a surgical microscope. Initially, in otorhinolaryngology practice, endoscopes were used for paranasal sinus surgeries. It was only later that they were applied in the area of otology. In otologic surgeries, endoscopes were first used to visualize the middle ear, before being used to assist with visualization of instruments during cholesteatoma surgeries, although they are still not used alone in various otologic surgeries. As in other surgical fields, there is also a trend towards minimally invasive intervention in the field of otorhinolaryngology. Smaller incisions performed under the guidance of endoscopes are preferred over conventional large incisions. Using this approach, improved outcomes can be achieved and postoperative morbidities can be reduced. In addition, the outcomes of grafts performed using the endoscopic approach are similar to that achieved by the microscopic approach. Therefore, endoscopic ear surgery implementations are becoming increasingly popular.
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Affiliation(s)
| | - Oner Sakallıoglu
- Elazig Education and Research Hospital, Clinic of ENT, Elazig, Turkey
| | - Turgut Karlidag
- Firat University, Faculty of Medicine, Department of Otolaryngology, Elazig, Turkey
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Imai T, Nishiike S, Oshima K, Tanaka H, Tsuruta Y, Tomiyama Y. The resected area of the posterior wall of the external auditory canal during transcanal endoscopic ear surgery for cholesteatoma. Auris Nasus Larynx 2017; 44:141-146. [DOI: 10.1016/j.anl.2016.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/24/2016] [Accepted: 06/06/2016] [Indexed: 11/25/2022]
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35
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Ikeda R, Kikuchi T, Kobayashi T. Endoscope-assisted silicone plug insertion for patulous Eustachian tube patients. Laryngoscope 2017; 127:2149-2151. [PMID: 28233914 DOI: 10.1002/lary.26498] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 12/20/2016] [Accepted: 12/27/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Ryoukichi Ikeda
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University, Graduate School of Medicine, Sendai, Japan.,Sen-En Rifu Otologic Surgery Center, Sendai, Japan
| | - Toshiaki Kikuchi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University, Graduate School of Medicine, Sendai, Japan
| | - Toshimitsu Kobayashi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University, Graduate School of Medicine, Sendai, Japan.,Sen-En Rifu Otologic Surgery Center, Sendai, Japan
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Abstract
Wullstein, the founder of modern microscopic ear surgery, already used an oto-endoscope intraoperatively. However, it is only after the recent development of modern video-endoscopy with high-definition, 4K, and 3‑dimensional imaging that endoscopically guided surgery of the middle ear is gaining some importance. Key ventilation routes like the isthmus tympani and the epitympanic diaphragm can be visualized far better using an endoscope than with a microscope. Going through the external meatus, surgery of middle ear pathologies is possible without external incision. This type of primary endoscopic ear surgery has to be distinguished from secondary endoscopic ear surgery, where standard microscopic ear surgery is supplemented by endoscopic surgery. Having to hold the endoscope in one hand, surgery has to be performed single-handedly, which is awkward. In cases of extensive bone removal or excessive bleeding, the view through the endoscope lens is obscured; therefore; the endoscope cannot fully substitute the microscope. It is, however, an interesting adjunct to microscopic ear surgery.
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Affiliation(s)
- S Preyer
- Ohrenschwerpunkt Karlsruhe am Diakonissenkrankenhaus, Diakonissenstr. 28, 76199, Karlsruhe, Germany.
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Wu C, Chen Y, Yang T, Lin K, Lee S, Liu T, Hsu C. Endoscopic versus microscopic management of congenital ossicular chain anomalies: our experiences with 29 patients. Clin Otolaryngol 2016; 42:944-950. [DOI: 10.1111/coa.12778] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2016] [Indexed: 11/27/2022]
Affiliation(s)
- C.C. Wu
- Department of Otolaryngology; National Taiwan University Hospital; Taipei Taiwan
| | - Y.H. Chen
- Department of Otolaryngology; National Taiwan University Hospital; Taipei Taiwan
| | - T.H. Yang
- Department of Otolaryngology; National Taiwan University Hospital; Taipei Taiwan
| | - K.N. Lin
- Department of Otolaryngology; National Taiwan University Hospital; Taipei Taiwan
- Department of Otolaryngology; Cardinal Tien Hospital; New Taipei Taiwan
| | - S.Y. Lee
- Department of Otolaryngology; National Taiwan University Hospital; Taipei Taiwan
- Department of Otolaryngology-Head and Neck Surgery; Chung Shan Medical University Hospital; Taichung Taiwan
| | - T.C. Liu
- Department of Otolaryngology; National Taiwan University Hospital; Taipei Taiwan
| | - C.J. Hsu
- Department of Otolaryngology; National Taiwan University Hospital; Taipei Taiwan
- Department of Otolaryngology; Taichung Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation; Taichung Taiwan
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39
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Pauna HF, Monsanto RC, Schachern PA, Costa SS, Kwon G, Paparella MM, Cureoglu S. The surgical challenge of carotid artery and Fallopian canal dehiscence in chronic ear disease: a pitfall for endoscopic approach. Clin Otolaryngol 2016; 42:268-274. [PMID: 27455393 DOI: 10.1111/coa.12712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Endoscopic procedures are becoming common in middle ear surgery. Inflammation due to chronic ear disease can cause bony erosion of the carotid artery and Fallopian canals, making them more vulnerable during surgery. The objective of this study was to determine whether or not chronic ear disease increases dehiscence of the carotid artery and Fallopian canals. DESIGN Comparative human temporal bone study. SETTING Otopathology laboratory. PARTICIPANTS We selected 78 temporal bones from 55 deceased donors with chronic otitis media or cholesteatoma and then compared those two groups with a control group of 27 temporal bones from 19 deceased donors with no middle ear disease. MAIN OUTCOME MEASURES We analysed the middle ear, carotid artery canal and Fallopian canal, looking for signs of dehiscence of its bony coverage, using light microscopy. RESULTS We found an increased incidence in dehiscence of the carotid artery and Fallopian canals in temporal bones with chronic middle ear disease. The size of the carotid artery canal dehiscence was larger in the middle ear-diseased groups, and its bony coverage, when present, was also thinner compared to the control group. Dehiscence of the carotid artery canal was more frequently located closer to the promontory. The incidence of Fallopian canal dehiscence was significantly higher in temporal bones from donors older than 18 years with chronic middle ear disease. CONCLUSION The increased incidence of the carotid artery and Fallopian canal dehiscence in temporal bones with chronic middle ear disease elevates the risk of adverse events during middle ear surgery.
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Affiliation(s)
- H F Pauna
- Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA.,Department of Otolaryngology, Head and Neck Surgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - R C Monsanto
- Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA.,Department of Otolaryngology and Head and Neck Surgery, Banco de Olhos de Sorocaba Hospital (BOS), Sorocaba, São Paulo, Brazil
| | - P A Schachern
- Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
| | - S S Costa
- Department of Ophthalmology and Otolaryngology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul (UFRGS), Brazil
| | - G Kwon
- Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
| | - M M Paparella
- Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA.,Paparella Ear, Head and Neck Institute, Minneapolis, MN, USA
| | - S Cureoglu
- Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
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Garcia LDB, Moussalem GF, Andrade JSCD, Mangussi-Gomes J, Cruz OLM, Penido NDO, Testa JRG. Transcanal endoscopic myringoplasty: a case series in a university center. Braz J Otorhinolaryngol 2016; 82:321-5. [PMID: 26642752 PMCID: PMC9444649 DOI: 10.1016/j.bjorl.2015.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 05/21/2015] [Accepted: 05/23/2015] [Indexed: 11/26/2022] Open
Abstract
Introduction Transcanal myringoplasty has the advantages of demanding lower operative time and minimal external incisions. It can be performed using the microscopic or endoscopic approach. In the last decade, the use of endoscopes in ear surgery has increased significantly. This technique may allow “around the corner” visualization of small recesses, through narrow spaces, without the aid of canalplasty in unfavorable ear canals. Objective To describe a case series of transcanal endoscopic myringoplasty performed in a university service. The characteristics, advantages, and disadvantages of this technique are also discussed. Methods A case series study, based on the chart review of patients submitted to transcanal endoscopic myringoplasty in the period from January of 2012 to October of 2014. Results Data from 22 patients were analyzed. Tympanic perforation closure three months after surgery was observed in 86.4% of all patients. There was statistically significant improvement in pure tone average thresholds after surgery (p < 0.001). Conclusion Transcanal endoscopic myringoplasty is a feasible, safe, and effective procedure; it can be an alternative to microscopic surgery.
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Is endoscopic ear surgery an alternative to the modified Bondy technique for limited epitympanic cholesteatoma? Eur Arch Otorhinolaryngol 2016; 273:2533-40. [PMID: 26742905 DOI: 10.1007/s00405-015-3883-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 12/23/2015] [Indexed: 12/11/2022]
Abstract
The objective of this study is to evaluate the outcomes of the modified Bondy's technique performed at our center and for limited epitympanic cholesteatomas and to debate the purported benefits of endoscopic surgery for the same indication. This is a retrospective study. 269 ears of 258 patients with a minimum of 5-year follow-up that were operated for limited epitympanic cholesteatoma using the modified Bondy's technique were included in the study. All patients had primary acquired cholesteatoma with good preoperative hearing in the affected ear and an intact ossicular chain. The outcomes of were analyzed and the results were compared with a literature review of outcomes of endoscopic ear surgery for the same indication. The mean follow-up was 81.63 months. The mean preoperative air-bone gap was 13.6 ± 7 dB. Intraoperatively, the ossicular chain was preserved in all patients. Postoperatively, there was no significant change from preoperative levels in mean air conduction, mean bone conduction and the air-bone gap. There were no recurrent cholesteatomas in our series. A residual pearl-like cholesteatoma was found lateral to the tympanic membrane in 8.1 % of ears, which was removed in the outpatient clinic. Three patients (1.2 %) developed stenosis of the meatoplasty. Eight (3.1 %) ears exhibited retraction pockets involving the attic. Postoperative ear discharge was observed in 1.5 % cases. The modified Bondy technique, which provides excellent postoperative outcomes, is the surgery of choice for limited epitympanic cholesteatomas. The endoscope, despite its better visualization of hidden areas does not provide a distinct overall technical advantage or better results over the microscope.
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Martellucci S, Gallo A. Re: "Myringotomy and Ventilation Tube Insertion with Endoscopic or Microscopic Technique in Adults". Otolaryngol Head Neck Surg 2015; 153:1076-7. [PMID: 26621926 DOI: 10.1177/0194599815603057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Novel Concept of Attaching Endoscope Holder to Microscope for Two Handed Endoscopic Tympanoplasty. Indian J Otolaryngol Head Neck Surg 2015; 68:230-40. [PMID: 27340643 DOI: 10.1007/s12070-015-0916-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/17/2015] [Indexed: 10/22/2022] Open
Abstract
UNLABELLED The well established techniques in tympanoplasty are routinely performed with operating microscopes for many decades now. Endoscopic ear surgeries provide minimally invasive approach to the middle ear and evolving new science in the field of otology. The disadvantage of endoscopic ear surgeries is that it is one-handed surgical technique as the non-dominant left hand of the surgeon is utilized for holding and manipulating the endoscope. This necessitated the need for development of the endoscope holder which would allow both hands of surgeon to be free for surgical manipulation and also allow alternate use of microscope during tympanoplasty. To report the preliminary utility of our designed and developed endoscope holder attachment gripping to microscope for two handed technique of endoscopic tympanoplasty. Prospective Non Randomized Clinical Study. Our endoscope holder attachment for microscope was designed and developed to aid in endoscopic ear surgery and to overcome the disadvantage of single handed endoscopic surgery. It was tested for endoscopic Tympanoplasty. The design of the endoscope holder attachment is described in detail along with its manipulation and manoeuvreing. A total of 78 endoholder assisted type 1 endoscopic cartilage tympanoplasties were operated to evaluate its feasibility for the two handed technique and to evaluate the results of endoscopic type 1 cartilage tympanoplasty. In early follow up period ranging from 6 to 20 months, the graft uptake was seen in 76 ears with one residual perforation and 1 recurrent perforations giving a success rate of 97.435 %. Our endocsope holder attachment for gripping microscope is a good option for two handed technique in endoscopic type 1 cartilage tympanoplasty. The study reports the successful application and use of our endoscope holder attachment for gripping microscope in two handed technique of endoscopic type 1 cartilage tympanoplasty and comparable results with microscopic techniques. LEVEL OF EVIDENCE IV.
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Khan MM, Parab SR. Endoscopic cartilage tympanoplasty: A two-handed technique using an endoscope holder. Laryngoscope 2015; 126:1893-8. [DOI: 10.1002/lary.25760] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/29/2015] [Accepted: 09/30/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Mubarak M. Khan
- Department of Otorhinolaryngology; Maharashtra Institute of Medical Education and Research Medical College; Pune India
| | - Sapna R. Parab
- Department of Otorhinolaryngology; Maharashtra Institute of Medical Education and Research Medical College; Pune India
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Endoscopic cartilage tympanoplasty in chronic otitis media. The Journal of Laryngology & Otology 2015; 129:1073-7. [DOI: 10.1017/s002221511500239x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectives:The use of endoscopic techniques is becoming more widespread in otological and neuro-otological surgery. One such procedure, endoscopic tympanoplasty, is used in chronic otitis media treatment. This study aimed to analyse the results of endoscopic transcanal cartilage tympanoplasty.Methods:Data of tubotympanic chronic otitis media patients who underwent transcanal endoscopic type I cartilage tympanoplasty between June 2012 and May 2013 were analysed. The main outcome measures were graft success and hearing improvement.Results:Graft success rates were 94.3 per cent and 92.5 per cent at post-operative months one and six, respectively. Post-operative air–bone gap values were significantly improved over pre-operative values (p < 0.01).Conclusion:Transcanal endoscopic type I cartilage tympanoplasty is a minimally invasive, effective and reliable surgical treatment option for chronic otitis media.
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Endoscopic "Push-Trough" Technique Cartilage Myringoplasty in Anterior Tympanic Membrane Perforations. Clin Exp Otorhinolaryngol 2015; 8:224-9. [PMID: 26330916 PMCID: PMC4553352 DOI: 10.3342/ceo.2015.8.3.224] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 07/25/2014] [Accepted: 08/14/2014] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To evaluate endoscopic push-through technique cartilage myringoplasty results. METHODS This prospective study was performed on patients with anterior tympanic membrane perforations and endoscopic push-through technique cartilage myringoplasty was performed between 2011 and 2013. The patients who did not have any cholesteatoma or otorrhea in the previous 3 months, and had an air bone gap ≤25 dB in their preoperative audiograms were included in the study. They were followed up with endoscopic examination and audiograms at 2nd, 6th, 12th, and 24th postoperative months. Pure tone averages were calculated at 0.5, 1, 2, and 4 kHz frequencies. RESULTS Of 32 patients, 19 were females and 13 were males. The mean age was 40.3 years (range, 16 to 62 years), and the mean follow-up period was 12.4 months (range, 6 to 24 months). Graft success rate was 87.5% in this study. Preoperative mean air conduction hearing threshold was 25.9 dB, and the mean air-bone gap was 11.9 dB while these values improved to 19.5 dB and 5.3 dB respectively in the postoperative period. The mean hearing gain was 6.4 dB. The analysis of preoperative and postoperative mean air conduction thresholds and air bone gap values of the patients revealed statistically significant differences. CONCLUSION Underlay cartilage myringoplasty with endoscopic push-through technique in anterior quadrant tympanic membrane perforations is an effective, minimally invasive and feasible method.
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Dedmon MM, Kozin ED, Lee DJ. Development of a Temporal Bone Model for Transcanal Endoscopic Ear Surgery. Otolaryngol Head Neck Surg 2015; 153:613-5. [DOI: 10.1177/0194599815593738] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 06/09/2015] [Indexed: 11/16/2022]
Abstract
Transcanal endoscopic ear surgery (TEES) is being increasingly used in chronic ear disease for cholesteatoma removal and middle ear reconstruction, reducing the need for a postauricular incision and mastoidectomy. However, TEES is a challenging technique even for the most experienced otologist, requiring one-handed dissection using angled instrumentation. We have therefore developed a high-fidelity dissection model incorporating key aspects of TEES and cholesteatoma removal to facilitate the acquisition of these skills. Artificial cholesteatoma was implanted into middle ear spaces of a human temporal bone via a facial recess approach. A pilot study was conducted whereby surgeons endoscopically elevated a tympanomeatal flap with artificial bleeding and removed artificial cholesteatoma with angled instrumentation. Surgeons were uniformly satisfied with the experience and felt it would translate into improved performance in the operating room. This study suggests that the TEES dissection model could become an integral tool in the training of emerging TEES techniques.
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Affiliation(s)
- Matthew M. Dedmon
- Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology–Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
| | - Elliott D. Kozin
- Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology–Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
| | - Daniel J. Lee
- Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology–Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
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Martellucci S, Pagliuca G, de Vincentiis M, De Virgilio A, Fusconi M, Gallipoli C, Rosato C, Gallo A. Myringotomy and Ventilation Tube Insertion with Endoscopic or Microscopic Technique in Adults. Otolaryngol Head Neck Surg 2015; 152:927-30. [DOI: 10.1177/0194599815576906] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/19/2015] [Indexed: 11/15/2022]
Abstract
The purpose of this study is to assess the feasibility of endoscopic-assisted myringotomy and ventilation tube insertion in adults affected by chronic otitis media with effusion, comparing the outcomes of this approach with those obtained with the traditional microscopic technique. Twenty-four patients were enrolled in this trial and alternately assigned to 2 groups of 12 subjects each. In group A, patients underwent myringotomy and ventilation tube insertion under endoscopic view, whereas in group B, the same procedure was performed traditionally using a microscope. All cases were evaluated 1 week after surgery and then monthly until tube extrusion. Type A tympanogram was achieved in 10 of 13 ears in both groups (76.92%). No significant difference in operative times or complication rates was observed ( P > .05). Endoscopic technique could be a viable alternative to the microscopic approach for myringotomy and ventilation tube positioning in adults affected by chronic otitis media with effusion.
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Affiliation(s)
- Salvatore Martellucci
- Department of Surgical Biotechnologies and Science, ENT Section, “Sapienza” University of Rome, Italy
| | - Giulio Pagliuca
- Department of Surgical Biotechnologies and Science, ENT Section, “Sapienza” University of Rome, Italy
| | - Marco de Vincentiis
- Department of Sensorial Organs, ENT Section, “Sapienza” University of Rome, Italy
| | - Armando De Virgilio
- Department of Sensorial Organs, ENT Section and Department of Surgical Science, “Sapienza” University of Rome, Italy
| | - Massimo Fusconi
- Department of Sensorial Organs, ENT Section, “Sapienza” University of Rome, Italy
| | - Camilla Gallipoli
- Department of Surgical Biotechnologies and Science, ENT Section, “Sapienza” University of Rome, Italy
| | - Chiara Rosato
- Department of Surgical Biotechnologies and Science, ENT Section, “Sapienza” University of Rome, Italy
| | - Andrea Gallo
- Department of Surgical Biotechnologies and Science, ENT Section, “Sapienza” University of Rome, Italy
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Abdelghany A. The button graft technique for perforations affecting less than 25% of the tympanic membrane: a non-randomised comparison of a new modification to cartilage tympanoplasty with underlay and overlay grafts. Clin Otolaryngol 2013; 38:208-16. [DOI: 10.1111/coa.12112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2013] [Indexed: 11/29/2022]
Affiliation(s)
- A.M. Abdelghany
- Department of Otorhinolaryngology; Benha university; Benha; Egypt
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