Endoscopic push through tragal cartilage tympanoplasty: A 10-year retrospective review of our technique and outcomes

Citation: Rahman KMA, Majeed K, Finnegan E, Keogh I. Endoscopic push through tragal cartilage tympanoplasty: A 10-yearretrospective review of our technique and outcomes. World J Otorhinolaryngol 2024; 11(2): 18-24URL: https: www.wjgnet.com 2218-6247 full v11 i2 18.htmDOI: https: dx.doi.org 10.5319 wjo.v11.i2.18INTRODUCTIONThe use of microscopes for middle ear surgery has been prominent since the 1950s[1]. Historically, tympanoplasties havebeen performed using a post-auricular incision, end-aural incision, or a trans-canal technique, using a microscope to assistin the procedure[2,3]. Although post-auricular and end-aural techniques are effective in tympanic membrane perforationclosures, the larger incisions and more extensive soft tissue dissection associated with the procedure leads to post-operative pain[1-4]. Microscopic trans-canal tympanoplasties avoid these aforementioned issues[1-4]. However, thistechnique is limited in its applicability to patients with perforations in the posterior half of the tympanic membrane, andin those with wider external auditory canals[2]. Furthermore, the microscope is limited to a straight-line view of thesurgical field[5]. Technological innovation through the introduction of endoscopes has led to the improvement of surgicalapproaches to the middle ear cavity[1,4].Endoscopic ear surgery (EES) has risen to prominence due to its minimally invasive nature avoiding external incisionsand tissue dissections[6,7]. The endoscope offers a wider view of the surgical area and allows the user to navigate aroundcorners, affording better visualization of difficult to access areas[5]. The angled view provided by endoscopes is partic-ularly important in visualizing the anterior aspects of the tympanic membrane[8]. This view provides ease of navigationaround anterior overhangs, allowing one to perform tympanoplasties more easily for anterior perforations that maynormally require end-aural or post-auricular incisions.EES can be classified according to Cohens classification, as outlined in Table 1[9]. Total EES are Cohen Class 3surgeries[9]. Endoscopes can be used for a variety of procedures, such as myringotomy, grommet insertion, explorationof the middle ear, and ossiculoplasty[8,10,11]. Although there is a steep learning curve associated with EES, thistechnique allows the primary surgeon to train others actively during the procedures.There are several sources of autologous grafts that have been employed for perforation closures in tympanoplasties[12]. These include temporalis fascia, tragal perichondrium, cartilage, fat, and fascia lata[12]. Although all of these areviable graft sources, a temporalis fascia graft is usually preferred due to its proximity to the surgical site[12]. However,cartilage grafts have become popular due to their significantly higher graft integration rates while providing im-provements in postoperative hearing outcomes[13]. Also, harvesting tragal cartilage graft for repair of tympanicmembrane perforations allows for optimal cosmesis due to the small size and location of the incision[14].The aim of this paper is to outline how Endoscopic Push Through Tragal Cartilage Tympanoplasty (EPTTCT) isperformed at University Hospital Galway and to evaluate the clinical outcomes, graft uptake, hearing change, andsurgical complications over a 10-year period.MATERIALS AND METHODSStudy designA single-center retrospective cohort study was performed. Ethical approval was obtained from the research ethicscommittee of University Hospital Galway. Patients who underwent EPTTCT between 2013 and 2023 were identified.Patients were included if they underwent Total Endoscopic Tympanoplasties (Cohen Class 3) for small ( 25% of thetympanic membrane) to medium ( 50% of the tympanic membrane) perforations using a tragal cartilage graft. Patientswere excluded as follows: (1) If they underwent complicated tympanoplasties (e.g., palisades technique); (2) had largeperforations ( 50% of the tympanic membrane); (3) alternate graft harvest sites were utilized (e.g., conchal cartilagegraft); (4) if additional surgical interventions were required (e.g., raising the tympanomeatal flap, ossicular chainreconstruction, canalplasty, or usage of microscope to complete the surgical intervention); and (5) if incomplete patientfollow-up post-surgery occurred. Patient information, including demographics, and surgical and clinical outcomes werecollected using theater registers and electronic health records. Measured outcomes included assessment of perforation (PDF) Endoscopic Push Through Tragal Cartilage Tympanoplasty: A Ten-Year Retrospective Review of Our Technique and Outcomes. Available from: https: www.researchgate.net publication 382881098_Endoscopic_Push_Through_Tragal_Cartilage_Tympanoplasty_A_Ten-Year_Retrospective_Review_of_Our_Technique_and_Outcomes [accessed Aug 06 2024].