Comparative study of endoscopic and microscopic tympanoplasty performed by a single experienced surgeon
Introduction
The main objectives of tympanoplasty are hearing recovery and the repair of the tympanic membrane perforation [1]. Microscopes have been used for tympanoplasty since the early 1950s [2]. In comparison, endoscopy of the middle ear was first introduced by Mer et al. in 1967 and was primarily indicated for diagnostic and visualization purposes [3]. The use of the endoscope in middle ear surgery began in the 1990s and has since gained global traction [4,5]. At present, endoscopes, as primary or secondary devices, are used for almost all types of middle ear surgery, such as for chronic otitis media, otosclerosis, and cochlear implantation [6,7]. Endoscopic tympanoplasty (ET) has various advantages over microscopic tympanoplasty (MT); it allows access to the middle ear cavity with a relatively small incision, reduces postoperative pain, and improves cosmetic results. It also provides a wider operative view by providing a wider viewing angle [8,9]. In addition, endoscopes, particularly angled endoscopes, can provide a direct field of view in concealed areas, such as the anterior and posterior epi-tympanic space, sinus tympani, and fascial recess, which are difficult to observe under a microscope [10]. Despite these advantages, ET is limited in that it is a one-handed surgery, which makes micromanipulation difficult; lacks three-dimensionality; and has an extended learning curve [11]. This study aimed to compare the surgical and functional outcomes of ET and MT for tympanic membrane and middle ear surgery.
Section snippets
Patients and assessment
We retrospectively analyzed patients who underwent a type 1 ET or MT between January 2013 and September 2019 at a tertiary academic medical center. Patients were assigned to the ET or MT group according to the surgical approach (endoscopic or microscopic, respectively). The inclusion criteria were: aged >18 years, and attended follow-up at our clinic for ≥3 months. With the exclusion criteria were: A history of prior chronic otitis media surgery, history of mastoidectomy, and inadequate
Results
The surgical and functional results of 81 patients who underwent microscopic (n = 44) and endoscopic (n = 37) tympanoplasty were analyzed and assigned to the MT group and ET group, respectively. The MT group had an average age of 43.1 ± 17.6 years and consisted of 21 women (47.7%) and 23 men (52.3%). The ET group had an average age of 49.8 ± 13.0 years and consisted of 27 women (73.0%) and 10 men (27.0%). The demographic characteristics and surgical outcomes of the MT and ET groups are
Discussion
Endoscopic ear surgery has the advantage of allowing surgeons to view the concealed area in a less invasive manner, but was not widely applied initially due to the limitations of low resolution and poor image quality. However, the advantages were maximized following advancements in optical technology and the development of high-resolution video systems and monitors [4,12]. Regardless, the stereoscopic view remains poor, only one hand can be used during surgery, and it takes a long time to
Conclusions
In conclusion, ET shortens the operation time and hospitalization period, and reduces the total cost of treatment compared to MT. Further, the hearing improvement and complications associated with ET were similar to those associated with MT. Therefore, ET is a safe, efficacious, and highly cost-effective surgical procedure.
Declaration of competing interest
The authors declare that they have no conflicts of interest.
Acknowledgments
This work was supported by a 2-Year Research Grant of Pusan National University.
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