Outcomes of Endoscopic Tympanoplasty for Large Perforations: A Multicenter Retrospective Study in South Korea
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Objectives. Endoscopic tympanoplasty (ET) provides minimally invasive transcanal access to the middle ear and improvesmiddle ear visibility for the treatment of tympanic membrane (TM) perforations. However, the literature on surgicaloutcomes for large TM perforations is lacking and limited to small series. This study aimed to evaluate the clinicalbenefits of ET for large TM perforations. Methods. This retrospective cohort study was conducted at nine tertiary referral hospitals in South Korea, where 252 pa-tients who underwent ET as primary surgery from September 2019 to August 2021 were included. The outcomemeasures included the graft success rate and pre- and postoperative audiometric data. Results. In 239 patients, the graft success rate of ET for large or subtotal perforations was 86.2% (206 patients), while thegraft failure rate was 13.8% (33 patients). The graft failure rate was directly correlated with surgical techniques, in-cluding overlay and medial or lateral underlay tympanoplasty (P =0.027). Lateral underlay tympanoplasty showedthe most favorable results. Sex, laterality, etiology, site and size of perforation, operation time, and graft materials didnot vary significantly between the graft success and failure groups (P >0.05). The mean air-bone gap (ABG) improvedsignificantly in both groups (graft success group: 10.0±0.6 dB and graft failure group: 7.7±0.3 dB; P <0.001). How-ever, the ABG improvement did not significantly differ between the groups. Analysis of covariance revealed that thepostoperative 500-Hz bone conduction threshold improved after successful ET (adjusted coefficient, –11.351; 95%confidence interval, –21.491 to –1.212; P =0.028). Conclusion. This study involved the largest population to date of large TM perforations treated by ET. The study findingssuggest that ET is feasible and effective in treating large TM perforations.
Abstract
Objectives. Endoscopic tympanoplasty (ET) provides minimally invasive transcanal access to the middle ear and improvesmiddle ear visibility for the treatment of tympanic membrane (TM) perforations. However, the literature on surgicaloutcomes for large TM perforations is lacking and limited to small series. This study aimed to evaluate the clinicalbenefits of ET for large TM perforations. Methods. This retrospective cohort study was conducted at nine tertiary referral hospitals in South Korea, where 252 pa-tients who underwent ET as primary surgery from September 2019 to August 2021 were included. The outcomemeasures included the graft success rate and pre- and postoperative audiometric data. Results. In 239 patients, the graft success rate of ET for large or subtotal perforations was 86.2% (206 patients), while thegraft failure rate was 13.8% (33 patients). The graft failure rate was directly correlated with surgical techniques, in-cluding overlay and medial or lateral underlay tympanoplasty (P =0.027). Lateral underlay tympanoplasty showedthe most favorable results. Sex, laterality, etiology, site and size of perforation, operation time, and graft materials didnot vary significantly between the graft success and failure groups (P >0.05). The mean air-bone gap (ABG) improvedsignificantly in both groups (graft success group: 10.0±0.6 dB and graft failure group: 7.7±0.3 dB; P <0.001). How-ever, the ABG improvement did not significantly differ between the groups. Analysis of covariance revealed that thepostoperative 500-Hz bone conduction threshold improved after successful ET (adjusted coefficient, –11.351; 95%confidence interval, –21.491 to –1.212; P =0.028). Conclusion. This study involved the largest population to date of large TM perforations treated by ET. The study findingssuggest that ET is feasible and effective in treating large TM perforations.
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