Department of Otorhinolaryngology, Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
J Otolaryngol Head Neck Surg. 2022 Nov 17;51(1):45. doi: 10.1186/s40463-022-00597-3.
Tympanoplasty using the interlay technique has rarely been reported in transcanal endoscopic ear surgery, unlike the underlay technique. This is because many surgeons find it challenging to detach the epithelial layer of the tympanic membrane using only one hand. However, the epithelial layer can be easily detached from the inferior part of the tympanic membrane. Another key point is to actively improve anteroinferior visibility even if the overhang is slight because most perforations and postoperative reperforations are found in the anteroinferior quadrant of the tympanic membrane. We report the application of the interlay technique in endoscopic tympanoplasty type I for tympanic perforations.
We retrospectively reviewed the medical records of 51 patients who had undergone tympanoplasty using the interlay technique without ossiculoplasty between 2017 and 2020. We then compared the data with those of patients who underwent microscopic surgery (MS) using the underlay technique between 1998 and 2009 (n = 104). No other technique was used in each group during this period. Repair of tympanic membrane perforation and hearing outcomes were assessed for > 1 year postoperatively.
The perforation sites were limited to the anterior, posterior, and anterior-posterior quadrants in 23, 1, and 27 ears, respectively. Perforations were closed in 50 of the 51 ears (98.0%), and the postoperative hearing was good (average air-bone [A-B] gap was 6.8 ± 5.8 dB). The surgical success rate for the repair of tympanic membrane perforation was not significantly different from the MS group (93.3%, P = 0.15). The average postoperative average A-B gap in the group that underwent the interlay technique was significantly different from that in the MS group (10.1 ± 6.6 dB, P < 0.01).
The interlay technique should be considered as one of the treatment methods in endoscopic surgery for tympanic perforations. Further study of the postoperative outcomes of this procedure should be conducted to establish the optimal surgical procedure for tympanic perforations.
This study was retrospectively approved by the Institutional Review Board of the Jikei University, Tokyo, Japan (approval number: 32-205 10286). Video abstract.
与使用下置法不同，经耳道内镜中耳手术中很少使用夹层技术进行鼓室成形术。这是因为许多外科医生发现仅用一只手很难分离鼓膜的上皮层。然而，上皮层可以很容易地从鼓膜的下部分离。另一个关键点是即使是轻微的突出，也要积极改善前下的可视性，因为大多数穿孔和术后再穿孔都发生在鼓膜的前下象限。我们报告了在 2017 年至 2020 年期间，应用夹层技术在没有听骨链成形术的情况下进行 I 型内镜鼓室成形术治疗鼓膜穿孔的情况。
我们回顾性分析了 2017 年至 2020 年间应用夹层技术行鼓膜穿孔修复术的 51 例患者的病历，同时与 1998 年至 2009 年间应用下置法行显微镜手术（MS）的 104 例患者的病历进行比较。在此期间，每组均未使用其他技术。术后>1 年评估鼓膜穿孔修复和听力结果。
23 只耳的穿孔部位局限于前、后和前-后象限，1 只耳的穿孔部位局限于后象限，27 只耳的穿孔部位局限于前-后象限。51 只耳中的 50 只（98.0%）穿孔闭合，术后听力良好（平均气骨导差为 6.8±5.8dB）。夹层技术组鼓膜穿孔修复的手术成功率与 MS 组无显著差异（93.3%，P=0.15）。行夹层技术组的术后平均气骨导差明显小于 MS 组（10.1±6.6dB，P<0.01）。
夹层技术应被视为经耳道内镜鼓膜穿孔治疗的方法之一。应进一步研究该手术的术后结果，以确定鼓膜穿孔的最佳手术方法。
本研究经日本顺天堂大学机构审查委员会批准（注册号：32-205 10286）。视频摘要。
