Endoscopic tympanoplasty type I for tympanic perforations: analysis of prognostic factors

Matteo Fermi; Francesco Maccarrone; Domenico Villari; Filippo Palermo; Matteo Alicandri-Ciufelli; Michael Ghirelli; Livio Presutti; Marco Bonali

doi:10.1007/s00405-020-06588-2

Endoscopic tympanoplasty type I for tympanic perforations: analysis of prognostic factors

Eur Arch Otorhinolaryngol. 2021 Dec;278(12):4715-4722. doi: 10.1007/s00405-020-06588-2. Epub 2021 Jan 12.

Authors

Matteo Fermi¹, Francesco Maccarrone², Domenico Villari¹, Filippo Palermo³, Matteo Alicandri-Ciufelli¹, Michael Ghirelli¹, Livio Presutti¹, Marco Bonali¹

Affiliations

¹ Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy.
² Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy. fra.maccarrone@gmail.com.
³ Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.

PMID: 33438041
DOI: 10.1007/s00405-020-06588-2

Abstract

Purpose: To assess the anatomical and functional outcomes of endoscopic transcanal tympanoplasty type I for tympanic membrane perforations.

Methods: Eight hundred thirty-five patients who underwent tympanoplasty between January 2011 and January 2019 were selected. Patients with tympanic membrane perforation treated with a transcanal endoscopic tympanoplasty type 1 and a follow-up period longer than 6 months have been retrospectively reviewed. The presence of cholesteatoma or ossicular chain dysfunctions were considered exclusion criteria. Eighty-one patients were included in the present study population. The main outcome was the rate of overall graft success. Secondary outcomes included hearing results. Prognostic factors related to both the abovementioned outcomes were assessed.

Results: Overall, 66 patients (81.5%) had a successful graft at the last follow-up evaluation. Mean follow-up was 22.1 (range 6-104) months. The anterior quadrants were entailed by the perforation in 62 (76.5%) cases. The overall success rate with cartilage (or cartilage and perichondrium) was 91.2% (p < 0.01). The median preoperative and postoperative ABG were 18.7 (13.4-25.6) and 7.5 (2.5-12.5), respectively, revealing a significant median improvement of 11.2 (p < 0.001). The type of graft and the postoperative tympanic membrane status were significantly associated with the audiologic outcome with p = 0.01 and p = 0.02, respectively.

Conclusions: Endoscopic tympanoplasty type I is a reliable technique with reasonable anatomic and audiologic results. Tympanic membrane grafting with cartilage (or cartilage and perichondrium) guarantees a higher rate of perforation closure and satisfactory hearing results. Anterior eardrum perforations can be successfully and safely managed with transcanal endoscopic approach avoiding postauricular approach and canalplasty.

Keywords: Endoscopic ear surgery; Endoscopic myringoplasty; Endoscopic tympanoplasty type I; TEES.

MeSH terms

Humans
Myringoplasty
Prognosis
Retrospective Studies
Treatment Outcome
Tympanic Membrane Perforation* / surgery
Tympanoplasty