Comparison of anterior and posterior tympanomeatal flap elevations in endoscopic transcanal tympanoplasty

Abstract

Background: There is not an ideal tympanomeatal flap incision type for transcanal procedures.

Aims/Objectives: Comparing the outcomes and feasibility of posteriorly and anteriorly based tympanomeatal flap incisions for anterior perforations in endoscopic transcanal cartilage tympanoplasty.

Material and methods: Twenty-six patients who had anterior TM perforation were included. Patients were divided into two groups with randomization. All of the data were prospectively collected. These included demographic data, date of the surgery, mean surgery time, preoperative and postoperative sixth-month pure-tone audiometry (PTA), type of tympanomeatal flap incision and graft healing success.

Results: Mean follow up time was 20.69 ± 5.03 months. Graft healing rate was 100% in both groups. There was no major complication in both of groups. Mean air bone gap level improvement of (dB HL) at all frequencies was 7.69 ± 2.83 dB HL in group 1 and 7.98 ± 3.08 dB HL in group 2 respectively. Regarding pre-and postoperative mean air bone gap levels and mean surgery times, there was no significant difference between groups (p>.05).

Conclusions and significance: For non-complicated anterior perforations that are less than 50% of TM, endoscopic transcanal cartilage tympanoplasty using anterior tympanomeatal flap elevation procedure was seemed minimally invasive and feasible to perform with successful audiologic and postoperative outcomes.

Chinese abstract

背景：对于经耳管手术来说, 鼓室皮瓣切口类型并不理想。

目的：比较内镜下经耳管软骨鼓室成形术中耳后和耳前前穿孔鼓室皮瓣切口的效果和可行性。

材料与方法：26例前TM穿孔患者。患者随机分为两组。所有数据都是前瞻性收集的。这些数据包括人口学数据、手术日期、平均手术时间、术前和术后6个月纯音测听（PTA）、鼓室皮瓣切口类型和移植修复成功率。

结果：平均随访时间为20.69 ± 5.03个月。两组移植愈合率均为100%。两组均无严重并发症。各频率下（dB HL）的平均气骨间隙水平, 第1组为7.69 ± 2.83 dB HL, 第2组为7.98 ± 3.08 dB HL。术前和术后平均气骨间隙水平和平均手术时长在两组间无显著性差异（P > 0.05）。

结论与意义：对于小于50%TM的非复杂前穿孔, 鼻内镜下经耳管软骨鼓室成形术（采用前鼓室皮瓣抬高术）似乎创伤微小并可行, 具有良好的听力和术后效果。

Keywords:

• Chronic otitis media
• transcanal endoscopic tympanoplasty
• tympanic membrane perforation
• tympanomeatal flap elevation

Disclosure statement

None of the authors has declared any conflict of interest (financial or non-financial) from being named as an author on the manuscript.

Informed consent was obtained from all individual participants included in the study.

Figure 1. Anterior tympanomeatal flap elevation and cartilage graft placing.

Figure 2. Endoscopic images of patient no: 3, right ear, (A) Anterior tympanic membrane perforation, (B) Tympanomeatal flap incision on posterior side can be seen on the posterior external auditory canal wall, (C) Posteriorly elevated tympanomeatal flap (D) Over-underlay cartilage graft placing, (E) Closure of tympanomeatal flap elevation, (F) Postoperative eight-month control.

Figure 3. Endoscopic images of patient no: 7, right ear(A) Anterior perforation can be seen (B) Tympanomeatal flap incision on anterior side between 1 to 6 o’clock, (C) Anterior elevation of tympanomeatal flap, (D) Underlay cartilage graft placing, (E) Closure of tympanomeatal flap, (F) Postoperative sixth month control.