Pediatric Otolaryngology Head Neck Surgery Division, Children Hospital "ASST Spedali Civili", Italy.
Department of Otolaryngology Head and Neck Surgery, "ASST Spedali Civili", Italy.
Int J Pediatr Otorhinolaryngol. 2022 Sep;160:111245. doi: 10.1016/j.ijporl.2022.111245. Epub 2022 Jul 16.
Endoscopic trans-canal tympanoplasty type I (ETT) is gradually diffusing worldwide. It mainly allows less invasive surgery in children with respect to a microscope approach by avoiding post-auricular access. The aim of this study is to illustrate our experience in endoscopic reconstruction of tympanic membrane, using autologous tragus perichondrium (TP) and non-autologous acellular porcine small intestinal sub-mucosa (SIS) as grafts.
Between January 2011 and December 2020, the results of a prospective non-randomized series of consecutive ETT were analyzed. The primary outcome was closure rate at 6 months and secondary outcomes are closure rates associated with age, size of perforation, type of perforation and middle ear status, presence of myringosclerosis, type of graft, status of contralateral ear, adenoidectomy and pre-postoperative ABG change. Statistical analysis was performed using the SPSS statistical package.
One hundred and sixteen consecutive procedures, mean age 9.4 years (range 4-17 years), were evaluated. TP and SIS grafts were used in 65 (56%) and 51 (44%) procedures, respectively. Mean duration of surgical procedure was 53 ± 21 min for SIS and 77 ± 18 min for TP (P = 0.001) Total graft intake was 82.8%; TP and SIS intake were 86.2% and 78.4% (P = 0.3), respectively. Graft intake w.r.t. in age stratified age groups was not statistically significant. Average preoperative and postoperative air-bone gap was 12.1 ± 7.6 dB and 5.5 ± 3.8 dB, respectively (P = 0.001). The difference in closure rates was not significant. Neither intra- nor postoperative complications were observed.
In children, ETT is an applicable and less invasive technique compared to the microscope and offers less morbidity. The use of SIS contributes additional less invasiveness to endoscopic surgery by avoiding tragus harvesting with a comparable success rate and granting significantly less surgical duration.
内镜经耳道鼓膜成形术 I 型（ETT）正在全球范围内逐渐普及。与显微镜方法相比，它主要通过避免耳后入路，为儿童提供了一种更具侵袭性的手术。本研究旨在展示我们使用自体耳屏软骨膜（TP）和非自体猪小肠黏膜下层（SIS）作为移植物进行内镜鼓膜重建的经验。
2011 年 1 月至 2020 年 12 月，对连续行 ETT 的前瞻性非随机系列的结果进行了分析。主要结果是 6 个月时的闭合率，次要结果是与年龄、穿孔大小、穿孔类型和中耳状况、是否存在鼓膜硬化、移植物类型、对侧耳状态、腺样体切除术和术前术后 ABG 变化相关的闭合率。统计分析采用 SPSS 统计软件包进行。
116 例连续手术，平均年龄 9.4 岁（4-17 岁），其中 65 例（56%）使用 TP 移植物，51 例（44%）使用 SIS 移植物。SIS 和 TP 手术的平均手术时间分别为 53±21 分钟和 77±18 分钟（P=0.001）。总移植物摄取量为 82.8%；TP 和 SIS 的摄取量分别为 86.2%和 78.4%（P=0.3）。根据年龄分层的年龄组，移植物摄取量无统计学意义。平均术前和术后气骨导差分别为 12.1±7.6dB 和 5.5±3.8dB（P=0.001）。闭合率差异无统计学意义。术中及术后均未观察到并发症。
与显微镜相比，ETT 是一种适用于儿童的、侵袭性较小的技术，可减少发病率。SIS 的使用通过避免耳屏采集，为内镜手术提供了额外的微创性，成功率相当，手术时间显著缩短。
