Endoscopic inlay butterfly cartilage tympanoplasty in pediatric patients

To present and to compare the results of microscopic and endoscopic inlay butterfly cartilage tympanoplasties (MIBCT and EIBCT) in pediatric patients with COM using tragal cartilage as a grafting material and to discuss the advantages and superiorities of endoscope use and IBCT in pediatric patients.

This retrospective study was carried out to evaluate the outcomes of 79 pediatric patients up to 16 years old who underwent either EIBCT (58 children) or MIBCT (21 children) between July 2013 and August 2017 at a tertiary referral hospital. Audiometric data including air-bone gap (ABG), air-bone gap gain, and air-conduction (AC) and bone-conduction (BC) thresholds, otologic examination findings involving size, side, and site of tympanic membrane perforations, the average lengths of surgery time, hospital stay, and follow-up period, technical success (TS), and functional success (FS) were all assessed by screening hospital records. The preoperative and postoperative averages of 0.5, 1, 2, and 3 kHz of pure-tone thresholds were used for the mean AC and BC thresholds according to the guidelines of the Committee on Hearing and Equilibrium.

TSs of EIBCT and MIBCT were achieved in 91.4 % (53/58) and 85.7% (18/21), respectively. The overall mean of ABG of EIBCT and MIBCT improved from 21.97±7.06 dB vs 20.90±4.78 dB preoperatively to 9.84±4.31 dB vs 9.33±3.54 dB postoperatively (p<0.05) thus the ABG gain was 12.00±7.32 dB and 11.57±5.49 dB, respectively. The mean lengths of surgery time were 28.03±4.79 minutes and 40.76±3.98 minutes, the mean lengths of hospital stay were 9.24±1.4 hours and 9.42±1.32hours, the lengths of follow-up period were 21.40±9.15 months and 23.19±9.40 months, in the order given.

EIBCT is a comfortable, attractive, and safer approach in pediatric patients with COM for both otologists and patients for many reasons including children's narrower external ear canal, endoscopes' wide field of view when compared with microscopes, instead of endaural, postauricular or transcanal circumferential insicions need for just a tragal incision for graft harvesting, and literature reports of satisfactory technical and functional results.