Comparative study of endoscopic and microscopic tympanoplasty performed by a single experienced surgeon

Abstract

Purpose

The use of endoscopes in otologic procedures has been increasing worldwide. This study aimed to compare the efficacy of microscopic tympanoplasty (MT) and endoscopic tympanoplasty (ET) for tympanic membrane and middle ear surgery.

Materials and methods

We retrospectively analyzed 81 patients who underwent MT (n = 44) and ET (n = 37) for chronic otitis media with tympanic membrane perforation performed by a single surgeon between January 2013 and September 2019. The hearing outcomes, graft success rate, complications, operation time and hospital stay, and cost-effectiveness were recorded and compared between groups. Hearing outcomes were determined by pure tone audiometry. Cost-effectiveness was determined by the operation cost and total cost.

Results

There was no significant difference between the MT and ET groups regarding demographic characteristics, with the exception of the male:female ratio. There was no significant difference in the pre- and postoperative air conduction, bone conduction thresholds, and air-bone gap values between the two groups, but a significant audiologic improvement was observed in both groups (p < 0.05). In terms of recurrence of tympanic membrane perforation, postoperative otorrhea, and discomfort symptoms, there was no significant difference between groups (p > 0.05). The operation time and hospital stay were shorter in the ET group than in the MT group (p < 0.05). There were no significant differences in operation cost between the two groups (p > 0.05), but the total cost was significantly lower in the ET group than the MT group (p < 0.05).

Conclusion

ET is as safe and medically efficacious as conventional MT, shortens the operation time and hospital stay, and is cost-effective.

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.