Bilateral same-day endoscopic transcanal cartilage tympanoplasty: initial results

Abstract Introduction: Same-day closure of bilateral tympanic membrane perforations is a quick and more comfortable procedure for the patients. However, conventional bilateral same-day tympanoplasty or myringoplasty has been rarely performed because of the theoretical risk of postoperative complications. Objective: To evaluate the advantages and outcomes of bilateral simultaneous endoscopic cartilage tympanoplasty in patients with bilateral tympanic membrane perforations. Methods: From February 2012 to March 2013, patients with bilateral dry tympanic membrane perforations who had some degree of hearing loss corresponding to the size and location of the perforation entered the study. There was no suspicion to disrupted ossicular chain, mastoid involvement or other middle or inner ear pathology. Endoscopic transcanal cartilage tympanoplasty was done using the underlay (medial) technique. The graft was harvested from cymba cartilage in just one ear with preservation of perichondrium in one side. A 1.5 cm × 1.5 cm cartilage seemed to be enough for tympanoplasty in both sides. Results: Nine patients (4 males and 5 females) with the mean age of 37.9 years underwent bilateral transcanal cartilage tympanoplasty in a same-day surgery. The mean duration of follow up was 15.8 months. There were detected no complications including hearing loss, otorrhea and wound complication with no retraction pocket or displaced graft during follow-up period. The grafts take rate was 94.44% (only one case of unilateral incomplete closure). The mean of air-bone gap overall improved from 13.88 dB preoperatively to 9.16 dB postoperatively (p < 0.05). Conclusion: Bilateral endoscopic transcanal cartilage tympanoplasty can be considered as a safe minimally invasive procedure that can be performed in a same-day surgery. It reduces the costs and operation time and is practical with a low rate of postoperative complications.

摘要 引言：双侧鼓膜穿孔同期当日闭合术对患者而言是一项快捷且舒适度更高的操作。然而，由于术后并发症的理论风险，传统双侧同期鼓膜成形术（tympanoplasty）或鼓膜修补术（myringoplasty）鲜少开展。
目的：评估双侧同期内镜下软骨鼓膜成形术（endoscopic cartilage tympanoplasty）用于双侧鼓膜穿孔患者的优势与临床结局。
方法：2012年2月至2013年3月期间，将存在与穿孔大小、位置相对应的不同程度听力损失的双侧干性鼓膜穿孔患者纳入本研究。排除疑似存在听骨链（ossicular chain）中断、乳突（mastoid）受累或其他中耳、内耳病变的患者。采用经耳道内镜下软骨鼓膜成形术，应用衬里（内侧）技术。移植物取自一侧耳的舟状窝软骨（cymba cartilage），保留其一侧的软骨膜。1.5 cm×1.5 cm大小的软骨即可满足双侧鼓膜成形术的需求。
结果：共9例患者（男4例，女5例），平均年龄37.9岁，接受了当日双侧经耳道软骨鼓膜成形术。平均随访时长为15.8个月。随访期间未观察到包括听力下降、耳漏及切口并发症在内的任何并发症，无鼓膜回缩囊或移植物移位情况发生。移植物成活率为94.44%（仅1例单侧不完全闭合）。整体气骨导差（air-bone gap）从术前平均13.88 dB改善至术后9.16 dB（p<0.05）。
结论：双侧经耳道内镜下软骨鼓膜成形术可被视为一项安全的微创手术，可在当日手术中完成。该术式可降低医疗成本与手术时长，操作切实可行，且术后并发症发生率较低。