The application of a 70° endoscope in performing transcanal middle ear surgery.
Journal
Journal of the Chinese Medical Association : JCMA
ISSN: 1728-7731
Titre abrégé: J Chin Med Assoc
Pays: Netherlands
ID NLM: 101174817
Informations de publication
Date de publication:
01 03 2021
01 03 2021
Historique:
pubmed:
23
12
2020
medline:
21
12
2021
entrez:
22
12
2020
Statut:
ppublish
Résumé
Endoscopes increase the expediency of transcanal middle ear surgery. However, the application of a 70° endoscope is limited and seldom discussed, mainly because of its large angle. We introduce our experiences with the 70° endoscope in transcanal middle ear surgery. This is a retrospective chart review of 127 patients with chronic otitis media who underwent middle ear surgery performed by the senior author in 2016 at a tertiary referral center. The types of eardrum perforation were classified as central, inferior, posterior, or anterior according to the main location of the hole. The demographics, surgical pictures, and operative records were reviewed. In 15 ears of the 127 patients, the ossicles were recognized directly by a microscope. In another 112 ears, the ossicles could not be identified under a microscope. Without elevating the tympanomeatal flap, the ossicles could be recognized in 72 of these 112 ears with endoscopes, especially the 70° endoscope. In 35 of these 112 ears, an incision to extend the drum perforation or creation of a small tympanomeatal flap in the posterior-superior canal was made to observe the ossicles. However, 5 of these 112 ears were still noted to have a narrow and/or curved ear canal and preoperatively needed to undergo endaural incisions. Among the other 122 patients who first underwent attempted transcanal surgery, 15 ears changed to endaural incisions. The drum perforations were repaired directly through the perforation in 107 ears via the transcanal route. One year after surgery, the air-bone gap closure was 16.0 ± 11.8 dB, and the graft take rate was 91.3%. With the help of a 70° endoscope, we can use the transcanal transperforation route to evaluate and reconstruct drum perforations and ossicular chains in appropriate patients. Hence, normal tissue injuries to the ear canal can be minimized.
Sections du résumé
BACKGROUND
Endoscopes increase the expediency of transcanal middle ear surgery. However, the application of a 70° endoscope is limited and seldom discussed, mainly because of its large angle. We introduce our experiences with the 70° endoscope in transcanal middle ear surgery.
METHODS
This is a retrospective chart review of 127 patients with chronic otitis media who underwent middle ear surgery performed by the senior author in 2016 at a tertiary referral center. The types of eardrum perforation were classified as central, inferior, posterior, or anterior according to the main location of the hole. The demographics, surgical pictures, and operative records were reviewed.
RESULTS
In 15 ears of the 127 patients, the ossicles were recognized directly by a microscope. In another 112 ears, the ossicles could not be identified under a microscope. Without elevating the tympanomeatal flap, the ossicles could be recognized in 72 of these 112 ears with endoscopes, especially the 70° endoscope. In 35 of these 112 ears, an incision to extend the drum perforation or creation of a small tympanomeatal flap in the posterior-superior canal was made to observe the ossicles. However, 5 of these 112 ears were still noted to have a narrow and/or curved ear canal and preoperatively needed to undergo endaural incisions. Among the other 122 patients who first underwent attempted transcanal surgery, 15 ears changed to endaural incisions. The drum perforations were repaired directly through the perforation in 107 ears via the transcanal route. One year after surgery, the air-bone gap closure was 16.0 ± 11.8 dB, and the graft take rate was 91.3%.
CONCLUSION
With the help of a 70° endoscope, we can use the transcanal transperforation route to evaluate and reconstruct drum perforations and ossicular chains in appropriate patients. Hence, normal tissue injuries to the ear canal can be minimized.
Identifiants
pubmed: 33350651
doi: 10.1097/JCMA.0000000000000481
pii: 02118582-202103000-00013
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
309-313Informations de copyright
Copyright © 2021, the Chinese Medical Association.
Déclaration de conflit d'intérêts
Conflict of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.
Références
Tarabichi M, Ayache S, Nogueira JF, Al Qahtani M, Pothier DD. Endoscopic management of chronic otitis media and tympanoplasty. Otolaryngol Clin North Am 2013; 46:155–63.
Hsu YC, Kuo CL, Huang TC. A retrospective comparative study of endoscopic and microscopic tympanoplasty. J Otolaryngol Head Neck Surg 2018; 47:44.
Choi N, Noh Y, Park W, Lee JJ, Yook S, Choi JE, et al. Comparison of endoscopic tympanoplasty to microscopic tympanoplasty. Clin Exp Otorhinolaryngol 2017; 10:44–9.
Kuo CH, Wu HM. Comparison of endoscopic and microscopic tympanoplasty. Eur Arch Otorhinolaryngol 2017; 274:2727–32.
Dündar R, Kulduk E, Soy FK, Aslan M, Hanci D, Muluk NB, et al. Endoscopic versus microscopic approach to type 1 tympanoplasty in children. Int J Pediatr Otorhinolaryngol 2014; 78:1084–9.
Pothier DD. Introducing endoscopic ear surgery into practice. Otolaryngol Clin North Am 2013; 46:245–55.
Tajudeen BA, Kennedy DW. Thirty years of endoscopic sinus surgery: what have we learned? World J Otorhinolaryngol Head Neck Surg 2017; 3:115–21.
Ghadersohi S, Carter JM, Hoff SR. Endoscopic transcanal approach to the middle ear for management of pediatric cholesteatoma. Laryngoscope 2017; 127:2653–8.
Preyer S. Endoscopic ear surgery - a complement to microscopic ear surgery. HNO 2017; 65(Suppl 1):29–34.
Chen CK, Hsieh LC. Clinical outcomes of exclusive transcanal endoscopic tympanoplasty with tragal perichondrium in 129 patients. Clin Otolaryngol 2018; 43:1624–8.
Furukawa T, Watanabe T, Ito T, Kubota T, Kakehata S. Feasibility and advantages of transcanal endoscopic myringoplasty. Otol Neurotol 2014; 35:e140–5.
Saliba I, Abela A, Arcand P. Tympanic membrane perforation: size, site and hearing evaluation. Int J Pediatr Otorhinolaryngol 2011; 75:527–31.
James AL. Endoscope or microscope-guided pediatric tympanoplasty? Comparison of grafting technique and outcome. Laryngoscope 2017; 127:2659–64.
Kozin ED, Gulati S, Kaplan AB, Lehmann AE, Remenschneider AK, Landegger LD, et al. Systematic review of outcomes following observational and operative endoscopic middle ear surgery. Laryngoscope 2015; 125:1205–14.
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; 12:28–31.
Marchioni D, Rubini A, Gazzini L, Alicandri-Ciufelli M, Molinari G, Reale M, et al. Complications in endoscopic ear surgery. Otol Neurotol 2018; 39:1012–7.
Aksoy F, Dogan R, Ozturan O, Eren SB, Veyseller B, Gedik O. Thermal effects of cold light sources used in otologic surgery. Eur Arch Otorhinolaryngol 2015; 272:2679–87.
Kozin ED, Lehmann A, Carter M, Hight E, Cohen M, Nakajima HH, et al. Thermal effects of endoscopy in a human temporal bone model: implications for endoscopic ear surgery. Laryngoscope 2014; 124:E332–9.
Ito T, Kubota T, Takagi A, Watanabe T, Futai K, Furukawa T, et al. Safety of heat generated by endoscope light sources in simulated transcanal endoscopic ear surgery. Auris Nasus Larynx 2016; 43:501–6.
Farahani F, Shariatpanahi E, Jahanshahi J, Poorolajal J. Diagnostic performance of endoscopic and microscopic procedures for identifying different middle ear structures and remaining disease in patients with chronic otitis media: a prospective cohort study. PLoS One 2015; 10:e0132890.