Endoscopic transtympanic tympanoplasty in the treatment of conductive hearing loss: early results.
OBJECTIVE
We describe our initial experience with endoscopic transtympanic tympanoplasty and evaluate whether this approach is adequate and minimally invasive in the treatment of conductive hearing loss.


METHODS
Prospective trial.


METHODS
University hospital.


METHODS
Nine patients underwent endoscopic transtympanic tympanoplasty, with an average follow-up period of 17 months. Presurgical diagnosis was made by transtympanic endoscopy through a perforation made by OtoScan laser-assisted myringotomy in the outpatient clinic.


METHODS
With clean endoscopic visualization, ossiculoplasty was performed by inserting a trimmed tragal cartilage through the myringotomy perforation made by laser-assisted myringotomy. Two types of ossiculoplasty were performed: columella reconstruction and interposition. The tympanic membrane was covered with a chitin membrane or sealed with a small piece of perichondrium from the tragal cartilage.


METHODS
Perioperative and postoperative complications and preoperative and postoperative hearing.


RESULTS
Endoscopic transtympanic tympanoplasty with columella and endoscopic transtympanic tympanoplasty with interposition were performed in seven and two patients, respectively. Insertion of the cartilage was performed without conversion to a conventional otomicroscopic technique. The average hearing level before the operation was 59 dB. After the endoscopic transtympanic tympanoplasty, the average improved to the level of 27 dB, with an average air-bone gap of 11 dB. The myringotomy perforation was closed within 2 to 3 weeks.


CONCLUSIONS
As opposed to conventional methods, this procedure does not require surgical exposure such as otosclerosis drilling and skin incision, and avoids the substantial risk of unnecessary injury to the chorda tympani. Endoscopic transtympanic tympanoplasty for a disrupted ossicular chain is an adequate and minimally invasive procedure and should prove to be a useful surgical procedure in future endoscopic tympanoplasty.
Kakehata
Seiji
S
Department of Otorhinolaryngology, Hirosaki University School of Medicine, Hirosaki, Japan.
Futai
Kazunori
K
Sasaki
Akira
A
Shinkawa
Hideichi
H
D000293:Adolescent; D000328:Adult; D002648:Child; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006314:Hearing Loss, Conductive / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000601:surgery*; D014433:Tympanoplasty / Q000379:methods*