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The Microscopic Transcanal Approach in Stapes Surgery Revisited
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Feasibility and advantages of transcanal endoscopic myringoplasty
Takatoshi Furukawa1, Tomoo Watanabe, Tsukasa Ito
1Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.
Objective:
When performing transcanal myringoplasty under a microscope, the total circumference of the perforation can be difficult to confirm in patients where the external ear canal is narrow and/or protruded. In such patients, a retroauricular incision approach is usually used. However, we have developed a transcanal endoscopic myringoplasty procedure, and the microscopic and endoscopic views are compared herein for the first time. The feasibility and advantages of transcanal endoscopic myringoplasty were examined.
Study Design:
A prospective case series.
Setting:
Tertiary referral center.
Patients:
Transcanal endoscopic myringoplasty was performed on 25 ears in 21 patients with chronic otitis media between September 2011 and December 2012.
Intervention:
Microscopic and endoscopic views were compared for each patient. The 2 fields of views were both recorded and evaluated to determine the advantages and disadvantages of microscopes and endoscopes. Myringoplasty was performed using an endoscopic technique while comparing views as necessary.
Results:
Endoscopic views revealed the entire tympanic membrane in a single field with clear visualization of the perforation edges even when the ear canal was curved. This clear visualization facilitated reliable refreshing of the perforation edges and grafting. The anterior edge of the perforation was not visible under microscopy in 5 of 25 ears. Under an endoscopic wide view, the tympanic cavity was observable through the perforation, and the orifice of the tube, ossicular chain, and tympanic isthmus were visible especially with large perforations. Transcanal endoscopic myringoplasty was successfully performed with a simple underlay technique or with an intracanal incision in cases of marginal perforation.
Conclusion:
Comparison of microscopic and endoscopic views revealed superior visualization and operability of the endoscopic approach as opposed to transcanal simple underlay myringoplasty. Transcanal endoscopic myringoplasty does not require surgical exposure such as a retroauricular skin incision to get an anterior view. Our results demonstrated that transcanal endoscopic myringoplasty can be performed, regardless of the perforation size and the narrowness and/or protrusion of external ear canal.
Insights
Transcanal endoscopic myringoplasty offers superior visualization and operability compared to microscopic approaches, especially in narrow ear canals. This technique avoids retroauricular incisions, enabling successful tympanic membrane repair regardless of perforation size.
Area of Science:
- Otolaryngology
- Minimally Invasive Surgery
Background:
- Transcanal myringoplasty using microscopes presents visualization challenges in narrow or protruding ear canals.
- Traditional approaches for difficult cases often require retroauricular incisions.
Purpose of the Study:
- To compare microscopic and endoscopic views in transcanal myringoplasty.
- To evaluate the feasibility and advantages of a novel transcanal endoscopic myringoplasty procedure.
Main Methods:
- A prospective case series of 25 ears in 21 patients with chronic otitis media.
- Comparison of microscopic and endoscopic visualization during transcanal myringoplasty.
- Endoscopic myringoplasty performed using a simple underlay or intracanal incision technique.
Main Results:
- Endoscopic views provided clear visualization of the entire tympanic membrane and perforation edges, even in curved ear canals.
- Microscopic visualization was limited in 5 of 25 ears for the anterior perforation edge.
- Endoscopic view allowed observation of the tympanic cavity, ossicles, and Eustachian tube orifice, particularly with large perforations.
Conclusions:
- Transcanal endoscopic myringoplasty offers superior visualization and operability over microscopic transcanal simple underlay myringoplasty.
- The endoscopic approach eliminates the need for retroauricular incisions to view the anterior tympanic membrane.
- This technique is effective for myringoplasty irrespective of perforation size or ear canal anatomy.
