Outcome of endoscopic assisted underlay myringoplasty for chronic otitis media mucosal inactive type: Endoscopic versus Microscopic approach
Introduction: Myringoplasty is a common surgical procedure done for chronic otitis media mucosal inactive type. Operative microscope provides a magnified image in a straight line so surgeon cannot visualize all deep areas of middle ear. These limitations are addressed in endoscopic permeatal myringoplasty.
Methods: This was cross sectional study conducted on 86 patients of chronic otitis media mucosal inactive type. Forty three patients were in endoscopic ear surgery and other forty three patients were in microscopic ear surgery. Underlay myringoplasty was performed with the help of either endoscope or microscope. Permeatal approach was used in endoscopic assisted myringoplasty and post auricular approach was used in microscopic assisted surgery. Underlay technique of myringoplasty was performed using cartilage perichondrium graft in all the patients. Post-operative evaluation was done in terms of graft uptake, operative time and postoperative complications compared with microscopic technique.
Results: The mean age of presentation was 29.33(SD=11.18) years and 27.74(SD=11.77) years (ranges 15-60 years) in endoscopic and microscopic group respectively (p = 0.525). The mean operating time was shorter in endoscopic group (55.81 minutes, SD=10.79) than microscopic group (92.44 minutes, SD=10.49) which was statistically significant (p<0.01). The graft uptake was 95.3% in endoscopic group and 88.4% in microscopic group. There was more success of graft uptake in endoscopic assisted group but it was not statistically significant. Regarding complications endoscopic group showed less complications (4.6%) compared to microscopic group (41.8%) in terms postoperative recovery and it was statistically significant (p<0.01).
Conclusion: Endoscope provides greater advantage over the microscope in myringoplasty surgery. Endoscope permeatal approach over postauricular approach should be utilized which takes less operative time, less postoperative complications and better graft uptake.
Keywords: cartilage perichondrium graft; endoscopic ear surgery; microscopic ear surgery; underlay myringoplasty
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