Department of Otolaryngology Chair, Centenario University Hospital of Rosario, Rosario, Argentina.
Department of Otolaryngology-Head and Neck Surgery Clinical Assistant Professor, Centenario University Hospital of Rosario, Urquiza 3101, 2000, Rosario, SF, Argentina.
Eur Arch Otorhinolaryngol. 2022 Jan;279(1):181-186. doi: 10.1007/s00405-021-06668-x. Epub 2021 Feb 13.
Demonstrate feasibility of performing endoscopic transcanal type 1 tympanoplasty in total and subtotal perforations, using an underlay technique that minimizes the risk of anterior medialization of the graft. Compare audiometric and clinical outcomes of this technique with our series of endoscopic tympanoplasty with classical underlay grafts, and with previously reported outcomes of microscopic post-auricular lateral graft tympanoplasty and other transcanal techniques.
We describe a surgical technique using an L-shaped cartilage and its perichondrium, with exclusive transcanal endoscopic approach. A retrospective review of patients undergoing this technique at the Centenario University Hospital of Rosario, Argentina between January 2017 and December 2019 was performed, and it was compared with a group of patients who underwent endoscopic tympanoplasty with classical underlay technique in a previous period of time. Patients with smaller perforations and other middle ear pathologies that required other techniques were not included in this study. Minimum follow up was 6 months. The main outcome measures were membrane closure rates and hearing results.
73 patients with total or subtotal perforations undergoing endoscopic transcanal tympanoplasty between 2015 and 2019 were included. The group of patients that underwent the technique described showed no anterior medialization of the graft, and better graft take rates. The hearing outcomes were similar in all successful graft patients, with postoperative average air-bone gap of 10db (+ - 10 dB).
Transcanal endoscopic tympanoplasty with the technique described is an excellent option for closure of total and subtotal tympanic perforations. The rate of perforation closure is better than endoscopic tympanoplasty with classical underlay graft with similar audiometric outcome.
展示使用覆盖技术在内镜经耳道 1 型鼓室成形术中治疗全层和次全层鼓膜穿孔的可行性，该技术可最大程度降低移植物前内侧化的风险。将该技术的听力和临床结果与我们使用经典覆盖移植物的内镜鼓室成形术系列以及以前报道的显微镜耳后外侧移植物鼓室成形术和其他经耳道技术的结果进行比较。
我们描述了一种使用 L 形软骨及其软骨膜的手术技术，该技术仅采用经耳道内镜方法。对 2017 年 1 月至 2019 年 12 月期间在阿根廷罗萨里奥百年大学医院接受该技术的患者进行了回顾性研究，并与同期接受经典覆盖移植物内镜鼓室成形术的患者进行了比较。未将穿孔较小和需要其他技术的其他中耳病变的患者纳入本研究。最小随访时间为 6 个月。主要观察指标是鼓膜封闭率和听力结果。
纳入了 2015 年至 2019 年间接受内镜经耳道鼓室成形术治疗的 73 例全层或次全层鼓膜穿孔患者。采用所描述技术的患者组未出现移植物前内侧化，移植物成活率更高。所有成功移植患者的听力结果相似，术后平均气骨导差为 10dB（+/-10dB）。
所描述的经耳道内镜鼓室成形术是治疗全层和次全层鼓膜穿孔的绝佳选择。封闭率优于经典覆盖移植物的内镜鼓室成形术，且听力结果相似。
