Endoscopic push through tragal cartilage tympanoplasty: A 10-year retrospective review of our technique and outcomes

BACKGROUND Endoscopic ear surgery(EES)provides a magnified,high-definition view of the otological surgical field.EES allows otologists to avoid surgical incisions and associated postoperative complications.It is an ideal technique for the perfor-mance and teaching of tympanoplasty.AIM To examine the efficacy of total Endoscopic Push Through Tragal Cartilage Tympanoplasty(EPTTCT),at our institution over a 10-year period.METHODS A retrospective analysis of 168 cases of EPTTCT for closure of small to medium tympanic membrane perforations from 2013-2023 was conducted.Patient sex,age range(pediatric vs adult),etiology of injury,success rate,complications,and postoperative hearing status were collected.RESULTS Graft uptake results indicated success in 94%of patients,with less than a 2%complication rate.Postoperative pure tone audiometry demonstrated hearing status improvement in 69%of patients.CONCLUSION EPTTCT has been shown to be effective in tympanic membrane perforation closures with minimal complications.This study further demonstrates the efficacy and safety of these procedures in a single-center review.

Endoscopic ear surgery

Objectives:This article reviews the advantages and disadvantages of endoscopic ear surgery(EES).Method:Pubmed,Google and the Proquest Central Database at Kirikkale University were queried using the keywords"endoscopic ear surgery","ear surgery"and"endoscopy"to identify the literature needed for the review.Results:Endoscopes allow for enhanced surgical visualisation.The distal part of the apparatus is illuminated and contains lenses angled to allow a wider view of the operative area.Transcanal endoscopic techniques have transformed the external ear canal(EAC)into an operative gateway.The benefits EES can offer include wider views,enhanced imaging capabilities and increased magnification,and ways to see otherwise poorly visualisable portions of the middle ear.EES permits surgeons to operate using minimally invasive otological techniques.When compared with microscope-assisted surgery,endoscopic tympanoplasty has been shown to require a shorter operating time in some instances.There are a number of drawbacks to EES,however,which include the fact that it is a single-handed technique,that the light source may produce thermal injury and that visualisation using the endoscope is severely curtailed if bleeding is profuse.Conclusion:EES is a safe and effective technique.The current literature supports the idea that the results achieved by endoscopic methods are usually comparably beneficial to results obtained using conventional microscopic methods.

Getting started in endoscopic ear surgery

Endoscopic ear surgery(EES) is an exciting, rapidly developing and innovative field of otologic surgery.Technically and conceptually, EES is a significant departure from traditional microscopic transcanal approaches to the middle ear and canal that has shown very positive results with respect to patient outcomes. This review serves as a primer for the otologist and otology resident embarking on EES and discusses the theory surrounding the learning process, the optical chain for endoscopic surgery as well as other important underlying principles.

Endoscopic ear surgery in middle ear cholesteatoma

Objective:Endoscope has been used as diagnostic tool for recidivism and as an adjunct to microscopic technique in the management of cholesteatoma.At present transcanal endoscopic ear surgery(TEES)is being used as a minimally invasive alternative for microscopic approach.We aim to evaluate the feasibility,structural,functional and quality of life outcomes of endoscopic technique in middle ear cholesteatoma.Method:This prospective study was conducted at a tertiary care hospital from January 2017 to January 2018 including 32 adult patients who were treated by TEES for middle ear cholesteatoma.Feasibility of endoscopic technique was assessed by the conversion rates,visualization of middle ear structures and complications.Structural outcomes were evaluated in terms of graft uptake at the third month follow-up and presence of residual or recurrent disease.Functional outcomes were evaluated in terms of postoperative air-bone gap closure at third month follow-up.Patient outcomes in terms of post-operative pain,cosmetic score,day of return to daily activities and patient comfort scores were evaluated.The quality of life outcomes were evaluated using chronic ear survey(CES)and short form questionnaire12 version 2(SF-12V2)which are disease specific and general quality of life assessment tools respectively.Result:Out of 32 patients,endoscopic intact canal wall mastoidectomy was done for 28 and endoscopic canal wall down mastoidectomy in 4 patients.One(3.1%)patient had to be converted to microscopic technique.Median follow-up period was 32.8 months(9e46 months).There were no post-operative complications in any of our patients.The mean middle ear structural visibility index score was 8.4±1.4 with the use of zero-degree endoscope.Graft uptake rate at third month follow-up was 100%.Two(6.3%)patients had recurrent disease at 6 months follow-up and were treated by revision endoscopic surgery.The air conduction(51.3±20.2 dB vs.34.5±20.4 dB,p<0.001),and air-bone gap(33.5±11.1 dB vs.16.9±11.8 dB,p<0.001)has been significantly improved.The mean pain score at 0 hours,6 hours and 24 hours after surgery were 2.5/10,1.6/10 and 0.75/10 respectively.At the discharge,the mean patient comfort score was 9.3±0.6 out of 10.Mean cosmetic score was 9.3±0.5 at the third month follow-up.There was significant post-operative improvement in the sub-scale and total scores of CES and SF-12V2.Conclusion:Endoscopic approach to middle ear cholesteatoma is feasible and confers excellent structural,functional as well as patient related quality of life outcomes.

Role of endoscopy in surgical management of cholesteatoma:A systematic review

Endoscopes are increasingly being used in cholesteatoma surgeries either as an adjunct to microscopes or sometimes exclusively.Their role at present is more as adjunct to microscope which still remains the work-horse for mastoidectomy.However,as endoscopy and endoscopic instruments are increasingly getting refined,role of endoscopy in management of cholesteatoma is continuously being appraised with progressively newer studies.This review aims to assess outcomes of several studies in which endoscopic techniques were used in cholesteatoma surgery and recognize common trends.An extensive review of literature on this theme was performed.Sixteen studies comprising of 1685 patients treated endoscopically either exclusively or in combination with microscope were included.Intra-operatively,in 267(15.82%)cases,residual cholesteatoma was identified by endoscope in hidden areas after completion of surgery with microscope.On follow-up,recidivism was identified in 108 cases(6.4%)in second look procedures.Common sites of recurrence were hidden areas like sinus tympani.This review while acknowledging the value of microscope,highlights the merit of endoscope usage in cholesteatoma surgery and its role in reducing recurrence.

Endoscopic transtympanic Eustachian tube dilatation: An overview of evaluation methods and dilatation technique

Endoscopic technique in patients undergoing chronic ear surgery allows visualization of protympanic(proximal)segment of the Eustachian tube(ET).The proximal cartilaginous ET is a common site of anatomical Obstruction in chronic otitis media and it is this proximal end of ET that is being observed,instrumented and dilated with transtympanic methods.The aim of this article is to discuss our approach to the assessment of the Eustachian tube using opening pressure measurement,endoscopic assessment of the protympanic segment of ET and Valsalva CT.And also to discuss detailed technique of transtympanic Eustachian tube dilatation.

Current trends and applications in endoscopy for otology and neurotology

There has been a rapid increase in endoscopic ear surgery for the management of middle ear and lateral skull base disease in children and adults over the last decade.In this review paper,we discuss the current trends and applications of the endoscope in the field of otology and neurotology.Advantages of the endoscope include excellent ergonomics,compatibility with pediatric anatomy,and improved access to the middle ear through the external auditory canal.Transcanal endoscopic ear surgery has demonstrated comparable outcomes in the management of cholesteatoma,tympanic membrane perforations,and otosclerosis as compared to microscopic approaches,while utilizing less invasive surgical corridors and reducing the need for postauricular incisions.When a postauricular approach is required,the endoscopic-assisted transmastoid approach can avoid a canal wall down mastoidectomy in cases of cholesteatoma.The endoscope also has utility in treatment of superior canal dehiscence and various skull base lesions including glomus tumors,meningiomas,and vestibular schwannomas.Outside of the operating room,the endoscope can be used during examination of the outer and middle ear and for debridement of complex mastoid cavities.For these reasons,the endoscope is currently poised to transform the field of otology and neurotology.