Restrospective Study Of Postoperative Effect Of Endoscopic And Microscopic Tympanoplasty

Objective: Through restrospective study under endoscopic and microscopic tympanoplasty type I、II、III,with middle ear disease cases of resection of type II or III,analysis of endoscopic and microscopic each tympanoplasty were the difference of curative effect,discusses the advantages and disadvantages of endoscopic surgery,as well as for different range of lesion should be how to choose the endoscope or microscope.Methods: A retrospective analysis was performed on 133 patients(138 ears)who received tympanoplasty in the The First Affiliated Hospital of Dalian Medical University from March 2016 to September 2020.According to the choice of surgical methods,they were divided into two groups: endoscopic group and microscopic group.The endoscopic group was divided into: Group A: tympanoplasty type I 37 cases;Group B: tympanoplasty type II 8 cases;Group C: tympanoplasty type III 7 cases;Group D: resection of middle ear lesions + tympanoplasty type II 8 cases;Group E: resection of middle ear lesions +tympanoplasty type III 7 cases;The microscopic group was divided into: Group A:tympanoplasty type I 37 cases;Group B: tympanoplasty type II 8 cases;Group C:tympanoplasty type III 7 cases;Group D: resection of middle ear lesions + tympanoplasty type II 8 cases;Group E: resection of middle ear lesions + tympanoplasty type III 7cases.In this study,patients in each group were followed up for surgery and postoperative conditions under endoscope and microscope,and the mean operative time,the recovery of tympanic membrane,ratio of recovering tympanic membrane 3 months after surgery,postoperative complications and the mean PTA and the mean ABG before and 3 months after surgery were compared and observed between the two groups.Result: The resulting data shows that the mean operation time and mean healing time of tympanic membrane in the ear endoscopy group(A,B,C,D,E)were all shorter than those in the microscope group,and P < 0.05,there was a significant difference.The total healing rate of tympanic membrane 3 months after surgery was 98.55% in the otoscope group and 100% in the microscope group,There was no significant difference between the two groups(P>0.05).The operation time in the endoscope group was significantly shorter than the microscope group,and the postoperative recovery was faster than it too.Compared with the microscopic group,the average PTA and average ABG at 3 months before and after operation were P>0.05,in the endoscopic group(A,B,C,D,E)there was no significant difference in hearing improvement between tympanoplasty under endoscope and microscope.In the endoscopic group(A,B,C,D,E)the average ABG at 3 months after surgery was(11.08±9.21 d BHL,22.75±12.05 d BHL,18.29±6.25 d BHL,14.75±7.08 d BHL,17.29±6.47 d BHL)respectively.The microscopic group(A,B,C,D,E)3 months after the average ABG was(15.28±10.03 d B HL,23.75±18.16 d B HL,27.00±9.47 d B HL,17.63±7.14 d B HL,27.14±9.37 d B HL)respectively,compared with the preoperative mean pneumobone differential was increased,and P<0.05 showed a significant difference.Therefore,hearing was improved after ear endoscopic or microscopic tympanoplasty.Follow-up period ranged from 3 months to 6 months was conducted in both the endoscopic group and the microscope group.The number of postoperative complications occurred in both the endoscopic group and the microscope group after 3 months to 6 months follow-up: 2cases in the endoscopic group(1 case each of ossicle displacement,fungal infection of external auditory canal),and 2 case in the microscope group(1 case each of recurrence of cholesteatoma one year after surgery and vertigo).There was no obvious difference in postoperative complicating diseases between the two groups(P>0.05).Conclusion: 1.Endoscopy has the characteristics of high-definition,wide-angle,multiangle and close-up observation,and can be applied to various types of surgery for tympanoplasty;2.In this study,middle ear endoscopy has obvious advantages over microscope in terms of operative time and healing time of tympanoplasty of various types.Endoscopy can replace microscope to complete all types of tympanoplasty without removal of middle ear lesions;3.In tympanoplasty with resection of middle ear lesions,total endoscopy can also complete most surgeries.