title: Feasibility and advantages of transcanal endoscopic myringoplasty.
abstract: OBJECTIVE
  When performing transcanal myringoplasty under a microscope, the total circumference of the perforation can be difficult to confirm in patients where the external ear canal is narrow and/or protruded. In such patients, a retroauricular incision approach is usually used. However, we have developed a transcanal endoscopic myringoplasty procedure, and the microscopic and endoscopic views are compared herein for the first time. The feasibility and advantages of transcanal endoscopic myringoplasty were examined.
  
  
  METHODS
  A prospective case series.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Transcanal endoscopic myringoplasty was performed on 25 ears in 21 patients with chronic otitis media between September 2011 and December 2012.
  
  
  METHODS
  Microscopic and endoscopic views were compared for each patient. The 2 fields of views were both recorded and evaluated to determine the advantages and disadvantages of microscopes and endoscopes. Myringoplasty was performed using an endoscopic technique while comparing views as necessary.
  
  
  RESULTS
  Endoscopic views revealed the entire tympanic membrane in a single field with clear visualization of the perforation edges even when the ear canal was curved. This clear visualization facilitated reliable refreshing of the perforation edges and grafting. The anterior edge of the perforation was not visible under microscopy in 5 of 25 ears. Under an endoscopic wide view, the tympanic cavity was observable through the perforation, and the orifice of the tube, ossicular chain, and tympanic isthmus were visible especially with large perforations. Transcanal endoscopic myringoplasty was successfully performed with a simple underlay technique or with an intracanal incision in cases of marginal perforation.
  
  
  CONCLUSIONS
  Comparison of microscopic and endoscopic views revealed superior visualization and operability of the endoscopic approach as opposed to transcanal simple underlay myringoplasty. Transcanal endoscopic myringoplasty does not require surgical exposure such as a retroauricular skin incision to get an anterior view. Our results demonstrated that transcanal endoscopic myringoplasty can be performed, regardless of the perforation size and the narrowness and/or protrusion of external ear canal.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Furukawa
authors.forename: Tomoo
authors.initials: T
authors.lastname: Watanabe
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Ito
authors.forename: Toshinori
authors.initials: T
authors.lastname: Kubota
authors.forename: Seiji
authors.initials: S
authors.lastname: Kakehata
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001309:Auditory Threshold; D001844:Bone Conduction; D002114:Calcinosis / Q000473:pathology; D002648:Child; D002908:Chronic Disease; D004424:Ear Canal / Q000002:abnormalities / Q000033:anatomy & histology; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009225:Myringoplasty / Q000379:methods*; D010033:Otitis Media / Q000601:surgery; D013506:Otologic Surgical Procedures / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000473:pathology / Q000601:surgery; D018058:Tympanic Membrane Perforation / Q000473:pathology / Q000601:surgery