Comparison of the clinical outcome of endoscopic push-through myringoplasty and microscopic overlay myringoplasty: matching co-variated designs

BMC Surgery

Kanokkarn Mahawerawat¹  Pornthep Kasemsiri² 

[1] Department of Otorhinolaryngology, Khon Kaen Hospital, Khon Kaen, Thailand;Skull Base Surgery Unit, Department of Otorhinolaryngology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, 40002, Khon Kaen, Thailand;Khon Kaen Ear Hearing and Balance Research Group, Khon Kaen University, Khon Kaen, Thailand;Srinagarind Minimally Invasive Surgery Center of Excellence, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand;Khon Kaen Head and Neck Oncology Research, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand;

关键词: Myringoplasty;    Endoscopy;    Microscopy;    Tympanic membrane;   

DOI  :  10.1186/s12893-022-01504-3

来源: Springer

【 摘 要 】

BackgroundThe conventional microscopic overlayer myringoplasty is preferred because it allows a both hands technique, not reducing middle ear space, increasing the blood supply in the repaired area, and providing graft support; however, this technique may be troublesome for the novice surgeon during tympanomeatal flap elevation. Recently, the endoscopic push-through myringoplasty technique has developed. It provides better visualization of the hidden areas and does not require raising tympanomeatal flap. Therefore, the comparison of clinical outcomes between endoscopic push-through myringoplasty and conventional microscopic overlay myringoplasty technique was investigated.MethodsA retrospective case–control hospital-based study was conducted using archival data from the patients who underwent myringoplasty between January 2015 and May 2021 at Srinagarind Hospital and Khon Kaen Hospital, Thailand. The medical records of patients who underwent endoscopic push-through technique or microscopic overlayer technique were chosen by simple randomization and matched 1:1 based on the air conduction threshold, air-bone gap, size of perforation, and experience of the surgeon. The two techniques were compared for clinical outcome success, including tympanic membrane closure, improved air conduction threshold, air-bone gap closure, and operation time duration.ResultsMedical records of 70 patients were retrieved and classified into 35 patients who underwent endoscopic push-through and 35 patients who underwent microscopic overlayer myringoplasty. The size of tympanic membrane perforation and preoperative audiometry were not significantly different between both groups (p > 0.05). The postoperative outcome in endoscopic technique revealed that the air-bone gap and the success rate of tympanic membrane closure were comparable with microscopic techniques (p = 0.420 and p = 0.156, respectively). The operation time was significantly shorter in the endoscopic technique (p < 0.05). Complications were found in one patient with otitis externa in the endoscopic technique group and one patient with graft lateralization in the microscopic technique group.ConclusionsEndoscopic push-through myringoplasty is an alternative minimally invasive technique that may allow the potential outcomes comparable with the microscopic overlayer myringoplasty and with a significantly shorter operation time.

【 授权许可】

CC BY