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Endoscopic vs microscopic myringoplasty: a different perspective.

Himani Lade¹, Santosha Ram Choudhary, Ashish Vashishth

¹Department of ENT and Head and Neck Surgery, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.

European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery

|September 4, 2013

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Transcanal endoscopic myringoplasty is a feasible and effective alternative to microscopic myringoplasty, offering comparable graft uptake and hearing outcomes with improved cosmetic results.

Area of Science:

Otolaryngology
Minimally Invasive Surgery
Surgical Techniques

Background:

Chronic otitis media with tympanic membrane perforations is a common condition.
Traditional microscopic myringoplasty involves a postaural approach.
Endoscopic techniques offer potential advantages in minimally invasive ear surgery.

Purpose of the Study:

To evaluate the feasibility of transcanal endoscopic underlay myringoplasty.
To compare endoscopic myringoplasty with microscopic myringoplasty regarding surgical outcomes.
To assess patient and resident feedback on the endoscopic approach.

Main Methods:

A prospective randomized trial comparing 30 endoscopic and 30 microscopic myringoplasties.
Transcanal approach with tympanomeatal flap elevation for endoscopic group.

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Postaural approach for microscopic group.

Assessment of graft uptake, hearing (pure tone audiometry), and cosmetic outcomes at 24 weeks.

Main Results:

No canalplasty or canal wall curettage needed in the endoscopic group, unlike the microscopic group.
Graft uptake rate of 83.3% in both groups at 24 weeks.
Similar hearing improvements (mean air-bone gap reduction) in both groups.
Superior subjective cosmetic outcomes reported for the endoscopic group.
Positive resident feedback on endoscopic myringoplasty feasibility.

Conclusions:

Transcanal endoscopic underlay myringoplasty is an effective alternative to microscopic myringoplasty.
The endoscopic approach provides excellent hearing outcomes and good cosmetic results.
Endoscopic myringoplasty may reduce the need for intraoperative procedures like canalplasty.