Fermi Matteo, Maccarrone Francesco, Villari Domenico, Palermo Filippo, Alicandri-Ciufelli Matteo, Ghirelli Michael, Presutti Livio, Bonali Marco
Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy.
Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
Eur Arch Otorhinolaryngol. 2021 Dec;278(12):4715-4722. doi: 10.1007/s00405-020-06588-2. Epub 2021 Jan 12.
To assess the anatomical and functional outcomes of endoscopic transcanal tympanoplasty type I for tympanic membrane perforations.
Eight hundred thirty-five patients who underwent tympanoplasty between January 2011 and January 2019 were selected. Patients with tympanic membrane perforation treated with a transcanal endoscopic tympanoplasty type 1 and a follow-up period longer than 6 months have been retrospectively reviewed. The presence of cholesteatoma or ossicular chain dysfunctions were considered exclusion criteria. Eighty-one patients were included in the present study population. The main outcome was the rate of overall graft success. Secondary outcomes included hearing results. Prognostic factors related to both the abovementioned outcomes were assessed.
Overall, 66 patients (81.5%) had a successful graft at the last follow-up evaluation. Mean follow-up was 22.1 (range 6-104) months. The anterior quadrants were entailed by the perforation in 62 (76.5%) cases. The overall success rate with cartilage (or cartilage and perichondrium) was 91.2% (p < 0.01). The median preoperative and postoperative ABG were 18.7 (13.4-25.6) and 7.5 (2.5-12.5), respectively, revealing a significant median improvement of 11.2 (p < 0.001). The type of graft and the postoperative tympanic membrane status were significantly associated with the audiologic outcome with p = 0.01 and p = 0.02, respectively.
Endoscopic tympanoplasty type I is a reliable technique with reasonable anatomic and audiologic results. Tympanic membrane grafting with cartilage (or cartilage and perichondrium) guarantees a higher rate of perforation closure and satisfactory hearing results. Anterior eardrum perforations can be successfully and safely managed with transcanal endoscopic approach avoiding postauricular approach and canalplasty.
评估内镜下I型经耳道鼓室成形术治疗鼓膜穿孔的解剖学和功能学结果。
选取2011年1月至2019年1月期间接受鼓室成形术的835例患者。对采用I型经耳道内镜鼓室成形术治疗鼓膜穿孔且随访期超过6个月的患者进行回顾性研究。存在胆脂瘤或听骨链功能障碍被视为排除标准。本研究纳入了81例患者。主要结局是移植物总体成功率。次要结局包括听力结果。评估与上述两种结局相关的预后因素。
总体而言，66例患者（81.5%）在最后一次随访评估时移植物成功。平均随访时间为22.1（范围6 - 104）个月。62例（76.5%）病例的穿孔累及前象限。使用软骨（或软骨和软骨膜）的总体成功率为91.2%（p < 0.01）。术前和术后ABG的中位数分别为18.7（13.4 - 25.6）和7.5（2.5 - 12.5），中位数显著改善11.2（p < 0.001）。移植物类型和术后鼓膜状态分别与听力学结局显著相关，p值分别为0.01和0.02。
内镜下I型鼓室成形术是一种可靠的技术，具有合理的解剖学和听力学结果。用软骨（或软骨和软骨膜）进行鼓膜移植可确保更高的穿孔闭合率和满意的听力结果。前鼓膜穿孔可通过经耳道内镜方法成功且安全地处理，避免耳后入路和外耳道成形术。
