An observational study of endoscopic versus microscopic type I tympanoplasty in tubotympanic chronic otitis media in a tertiary health care centre
Keywords:Chronic otitis media, Tubotympanic, Type I tympanoplasty
Background: Chronic otitis media (COM) is a widespread disease in the developing countries. It is treated by tympanoplasty, traditionally performed with the microscope which limits the visual field in the deep recesses of the middle ear, especially in narrow external auditory canal. Using endoscope has minimised these difficulties by providing a wide field view with angled magnification, reducing the duration of surgery. The advantages and disadvantages of both techniques is evaluated in our study.
Methods: In this observational study, 60 patients of tubotympanic COM between 12-60 years of age with small to medium sized central perforation and air-bone gap of less than 45 decibel were included. They were divided into two groups (group A and group B) of 30 patients each. Group A underwent microscopic type 1 tympanoplasty and group B underwent endoscopic type 1 tympanoplasty. The duration of the surgery, the post-operative improvement in hearing and the graft uptake was analysed after 3 months of surgery. The post-operative hospital stay duration was noted.
Results: The post-operative hearing improvement and the graft uptake after 3 months of the surgery was statistically not significant between the two groups. But the mean duration of the operation and the post-operative hospital stay was significantly lower in the endoscopic group with a p value <0.05.
Conclusions: Endoscopes are better in otological procedures as it reduces the surgical duration, provides better visibility, lessens the post-operative hospital stay, reducing the economic burden of the patient.
Gadag RP, Godse A, Narasaiah MD, Shetty N, Salian PL. Comparative study of outcomes of microscopic versus endoscopic myringoplasty. Med Inn. 2016;5(1):3-6.
Hussain Z. Mucosal chronic otitis media. In: Nair S (Ed). Otorhinolaryngology. 4th ed. Hyderabad: Paras. 2018;125-40.
Zahid T, Ahmed Z, Aqeel Z. Microbiology of chronic suppurative otitis media (CSOM) in tertiary care setup, Civil Hospital Karachi, Pakistan. Pak J Surg. 2016;32(3):176-80.
Orji F. A survey of the burden of management of chronic suppurative otitis media in a developing country. Ann Med Health Sci Res. 2013;3(4):598-601.
Bansal M. Middle Ear and Mastoid Surgeries. Essentials of Ear, Nose & Throat. 1st ed. New Delhi: Jaypee. 2016;438-9.
Huang TY, Ho KY, Wang LF, Chien CY, Wang HM. A comparative study of Endoscopic And Microscopic Approach Type 1 Tympanoplasty for Simple Chronic Otitis Media. J Int Adv Otol. 2016;12(1):28-31.
Sismanis AA. Tympanoplasty: tympanic membrane repair. In: Gulya AJ, Minor LB, Poe DS (Eds). Glasscock and Shambaugh Surgery of the Ear. 6th ed. Shelton: PMPH-USA. 2010;465-86.
Karhuketo TS, Puhakka HJ. Endoscope- guided round window fistula repair. Otol Neurotol. 2001;22(6):869-73.
Guindy A. Endoscopic transcanal myringoplasty. J Laryngol Otol. 1992;106(6):493-5.
Dündar R, Kulduk E, Soy FK, Aslan M, Hanci D, Muluk NB, Cingi C. Endoscopic versus microscopic approach to type 1 tympanoplasty in children. Int J Pediatr Otorhinolaryngol. 2014;78(7):1084-9.
Khatoon A, Rizvi M, Sultan A, Khan F, Sharma M, Shukla I, Khan HM. Chronic suppurative otitis media: a clinico-microbiological menace. Int J Res Med Sci. 2015;3(8):1932-6.
Kumar KR, Navya S, Basavarajappa KG. A study of Bacterial Profile and Antibiotic susceptibility Pattern of ChronicSuppurative Otitis Media among patients attending a Tertiary Care Centre, Davengere. Sch J App Med Sci. 2014;2(5B):1606-12.
Akinpelu OV, Amusa YB, Komolafe EO, Adeolu AA, Oladele AO, Ameye SA. Challenges in management of chronic suppurative otitis media in a developing country. J Laryngol Otol. 2008;122(1):16-20.
Okafor BC. Otolaryngology in South-Eastern Nigeria I. Pattern of disease of the ear. Niger Med J. 1983;13:11-9.
Kabdwal N, Varshney S, Bist SS, Bhagat S, Mishra S, Agarwal V. Pre and post-operative evaluation of hearing in chronic suppurative otitis media. Indian J Otol. 2013;19(4):164-8.
Darad H, Sinha M. Aetiological factor for chronic suppurative otitis media: a retrospective study. Int J Otorhinolaryngol Head and Neck Surg. 2017;3(2):234-8.
Zakzouk SM, Hajjaj MF. Epidemiology of chronic suppurative otitis media among Saudi children—a comparative study of two decades. Int J Pediatr Otorhinolaryngol. 2002;62(3):215-8.
Islam MS, Islam MR, Bhuiyan MA, Rashid MS, Datta PG. Pattern and degree of hearing loss in chronic suppurative otitis media. Bangladesh J Otorhinolaryngol. 2010;16(2):96-105.
S H C, M M K, Handi P, Khavasi P, Doddmani SS, Riyas M. To Study the Level of Awareness About Complications of Chronic Suppurative Otitis Media (CSOM) in CSOM Patients. J Clin Diagn Res. 2014;8(2):59-61.
Kumar N, Chilke D, Puttewar MP. Clinical Profile of Tubotympanic CSOM and Its Management With Special Reference to Site and Size of Tympanic Membrane Perforation, Eustachian Tube Function and Three Flap Tympanoplasty. Indian J Otolaryngol Head Neck Surg. 2012;64(1):5-12.
Garcia Lde B, Moussalem GF, Andrade JS, Mangussi-Gomes J, Cruz OL, Penido Nde O, Testa JR. Transcanal endoscopic myringoplasty: a case series in a university center. Braz J Otorhinolaryngol. 2016;82(3):321-5.
Jana S, Mandal S. A Comparative Study of Microscopic and Endoscopic Type I Tympanoplasty. Int J Contemp Med Res.2018;5(10):11-4.
Raj A, Meher R. Endoscopic transcanal myringoplasty-A study. Indian J Otolaryngol Head Neck Surg. 2001;53(1):47-9.
Awad OG, Hamid KA. Endoscopic type 1 tympanoplasty in pediatric patients using tragal cartilage. JAMA Otolaryngol Head Neck Surg. 2015;141(6):532-8.
Subramanya BT, Lohith S, Sphoorthi B. Endoscopic myringoplasty: outcome and hearing gain in inactive mucosal chronic otitis media. Int J Otorhinolaryngol Head Neck Surg.2019;5(2):330-5.
Patel J, Aiyer RG, Gajjar Y, Gupta R, Raval J, Suthar PP. Endoscopic tympanoplasty vs microscopic tympanoplasty in tubotympanic CSOM: a comparative study of 44 cases. Int J Res Med Sci. 2015;3(8):1953-7.
Lade H, Choudhury SR, Vasistha A. Endoscopic versus Microscopic Myringoplasty: A different perspective. Eur Arch Otorhinolaryngol. 2014;271:1897-902.