Endoscopic transcanal myringoplasty:Is learning curve a myth?

Area of Science:

• Otolaryngology
• Minimally Invasive Surgery
• Surgical Education

Background:

• Tympanic membrane perforations are common ear conditions.
• Traditional myringoplasty techniques can have limitations.
• Evaluating new surgical approaches is crucial for improving patient outcomes and surgical training.

Purpose of the Study:

• To assess the feasibility and outcomes of transcanal endoscopic myringoplasty.
• To evaluate the procedure's effectiveness when performed by novice surgeons.
• To determine the learning curve and safety profile of this technique in beginner hands.

Main Methods:

• A prospective study involving 42 patients (44 ears) was conducted over three years.
• Beginner surgeons, recently completed residency, performed transcanal endoscopic myringoplasty.
• The study was conducted in a subdistrict hospital in the Himalayan region.

Main Results:

• A high success rate of 90.9% for complete perforation closure was achieved at six months.
• Significant improvements in air conduction pure-tone average (PTA) and air-bone (AB) gap were observed postoperatively.
• The mean air conduction PTA improved from 40.84 dB HL to 28.06 dB HL (p < .001).
• The mean AB gap improved from 22.40 dB to 9.1 dB (p < .001).

Conclusions:

• Endoscopic transcanal myringoplasty is a safe and reliable surgical option.
• Beginner surgeons can confidently adopt this technique early in their careers.
• The endoscopic approach offers cost-effectiveness, being approximately one-tenth the cost of microscope-assisted open procedures.