Tungs’ Medical Journal (Jan 2023)
A comparative study of endoscopic tympanoplasty versus microscopic tympanoplasty in simple chronic otitis media
Abstract
Background: Otologic surgeries previously used microscopes, requiring large incisions. Recent advances in medical optical resolutiosn allows the introduction of the otologic endoscope as a less invasive alternative, providing better visualization and accessibility. Endoscopic surgery is now preferred for type 1 tympanoplasty and cholesteatoma treatment. Objectives: This study aims to compare the outcomes between patients who underwent endoscopic tympanoplasty and those who underwent microscopic tympanoplasty without ossiculoplasty or mastoidectomy. Methods: We retrospectively examined the data of 191 patients (201 ears) who underwent tympanoplasty without ossiculoplasty or mastoidectomy using either an endoscope or a microscope in the Department of Otolaryngology, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan, from July 1, 2014 to June 30, 2019. We compared the surgical and functional outcomes between the two approaches. We also analyzed the relationship between the two approaches and the size of the perforated tympanic membrane. Results: Endoscopic and microscopic tympanoplasties were performed in 67 and 134 ears, respectively. The preoperative pure tone average or air-bone gap values between the two groups were not statistically significant. The tympanic membrane healing rates for the four subgroups were classified according to the perforation size (Q1 : ≤ 25%, Q2 : > 25% & ≤ 50%, Q3 : > 50% & ≤ 75%, and Q4 : > 75% & ≤ 100%) were 90.9%, 94.1%, 95.0%, and 87.5% (P = 0.893), respectively, for the endoscopic group, and 97.0%, 86.4%, 97.1%, and 72.7% (P = 0.011), respectively, for the microscopic group. The postoperative improvement in the air-bone gap and pure tone average values between the two groups was not statistically significant. When considering the perforation size, the improvement in air-bone gap values was significantly different among the endoscopic groups (−1.0, −11.1, −3.9, and −7.8 dB, P = 0.002 for Q1, Q2, Q3 and Q4, respectively). Additionally, the procedure was markedly shorter in cases that underwent endoscopic surgeries for tympanic membrane perforation size of <25% (P = 0.007). Conclusion: Patients who underwent endoscopic and microscopic tympanoplasties without ossiculoplasty or mastoidectomy showed similar surgical and functional outcomes. Moreover, the procedural duration was markedly shortened in cases that underwent endoscopic surgeries, especially for those with small-sized perforations of the tympanic membrane.
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