Endoscope or microscope-guided pediatric tympanoplasty? Comparison of grafting technique and outcome.

OBJECTIVES/HYPOTHESIS: To review experience from the introduction of totally endoscopic ear surgery (TEES) to a pediatric tympanoplasty practice to identify factors influencing technique selection and successful outcome.

STUDY DESIGN

Prospective cohort study.

METHODS

Analysis of prospectively acquired data from a consecutive series of 295 surgeries for tympanic membrane perforation over a 12-year period. Success of perforation closure was compared between microscope and TEES grafting techniques. Impact of the acquisition of endoscopic techniques and equipment were compared with annual proportion of cases completed by TEES.

RESULTS

Of 267 tympanoplasties, 109 (41%) were completed with TEES and 158 by a postauricular approach. The proportion completed with TEES increased gradually to 97% of cases as equipment and expertise were acquired. Young age did not prevent TEES tympanoplasty. Two hundred nineteen of 250 (88%) perforations were closed successfully by tympanoplasty, with equivalent closure rates between TEES and postauricular approaches. Underlay of tragal perichondrium was less successful than lateral graft technique using TEES (P = .04, Fisher exact test). "Push-through" myringoplasty using a microscope or endoscope was least successful (19 of 28 (68%), P = .005). The median length of stay was 13 hours shorter for TEES than postauricular tympanoplasty (P = .04, Mann-Whitney rank sum test). Wound complications occurred in five (3%) postauricular cases and one TEES case.

CONCLUSIONS

TEES tympanoplasty is feasible in a large majority of children given appropriate equipment and surgical experience. Nonautogenous graft material is ideal for this minimally invasive approach. TEES is recommended as providing equivalent likelihood of perforation closure to the post-auricular approach but with less postoperative morbidity.

LEVEL OF EVIDENCE

2b. Laryngoscope, 127:2659-2664, 2017.