Michigan Ear Institute, Farmington Hills, Michigan.
Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Otol Neurotol. 2024 Jul 1;45(6):671-675. doi: 10.1097/MAO.0000000000004220.
To analyze the outcomes of exoscopic versus microscopic type 1 tympanoplasty.
Retrospective chart review.
Tertiary care otology-neurotology practice.
Adult subjects with a diagnosis of tympanic membrane perforation from 2018 to 2022.
Exoscopic or microscopic tympanoplasty with cartilage + perichondrium or perichondrium/fascia graft.
Primary outcomes were graft success rate (1 wk, 3 wk, 3 mo, and 6 mo postoperatively) and operative time. Secondary outcomes included audiometric outcomes of postoperative air-bone gap (ABG), change in ABG, pure tone average (PTA), speech reception threshold (SRT), and word recognition score (WRS) at 6-month follow-up and complication rates of cerebrospinal fluid leak, facial nerve injury, persistent tinnitus, and persistent vertigo.
Seventy-one patients underwent type 1 tympanoplasty by a single surgeon. Thirty-six patients underwent exoscopic tympanoplasty, and 35 patients underwent microscopic tympanoplasty. Cartilage and perichondrium were utilized in 27 subjects (75.0%) in the exoscopic group and in 25 subjects (71.4%) in the microscopic group (p = 0.7, Cramer's V = 0.04). Graft success rate was as follows (exoscope versus microscope): 100% (36/36) versus 100% (35/35) at 1 week (p = 1.0, Cramer's V = 0.0), 97.2% (35/36) versus 100% (35/35) at 3 weeks (p = 1.0, Cramer's V = 0.1), 97.2% (35/36) versus 94.3% (33/35) at 3 months (p = 1.0, Cramer's V = 0.07), and 91.7% (33/36) versus 91.4% (32/35) at 6 months (p = 0.7, Cramer's V = 0.0). Operative time was 57.7 minutes for the exoscopic group and 65.4 minutes for the microscopic group (p = 0.08, 95% CI [-16.4, 0.9], Cohen's d = 0.4). There were no serious complications. All preoperative and postoperative audiometric outcomes were comparable.
The outcomes after exoscopic versus microscopic type 1 tympanoplasty are comparable.
分析经耳内镜与显微镜下 1 型鼓室成形术的疗效。
回顾性病历分析。
三级耳鼻喉科听力神经科。
2018 年至 2022 年间，患有鼓膜穿孔的成年患者。
经耳内镜或显微镜下采用软骨+软骨膜或软骨膜/筋膜移植物进行鼓室成形术。
主要疗效指标为（术后 1 周、3 周、3 个月和 6 个月）移植物成功率和手术时间。次要观察指标包括术后气骨导差（ABG）、ABG 变化、纯音听阈平均值（PTA）、言语接受阈（SRT）和 6 个月随访时的言语识别率（WRS），以及脑脊液漏、面神经损伤、持续性耳鸣和持续性眩晕的并发症发生率。
71 例患者由同一位外科医生进行了 1 型鼓室成形术。36 例患者行经耳内镜鼓室成形术，35 例患者行显微镜下鼓室成形术。在外窥镜组中，27 例（75.0%）患者使用软骨和软骨膜，在显微镜组中，25 例（71.4%）患者使用软骨和软骨膜（p=0.7，Cramer's V=0.04）。移植物成功率如下（外窥镜与显微镜）：术后 1 周分别为 100%（36/36）与 100%（35/35）（p=1.0，Cramer's V=0.0），3 周时分别为 97.2%（35/36）与 100%（35/35）（p=1.0，Cramer's V=0.1），3 个月时分别为 97.2%（35/36）与 94.3%（33/35）（p=1.0，Cramer's V=0.07），6 个月时分别为 91.7%（33/36）与 91.4%（32/35）（p=0.7，Cramer's V=0.0）。外窥镜组的手术时间为 57.7 分钟，显微镜组为 65.4 分钟（p=0.08，95%CI[-16.4，0.9]，Cohen's d=0.4）。无严重并发症。所有术前和术后的听力结果均相似。
经耳内镜与显微镜下 1 型鼓室成形术的疗效相当。
