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Original Investigation
November 2016

Endoscopic Transcanal Myringoplasty for Anterior Perforations of the Tympanic Membrane

Author Affiliations
  • 1Department of Otolaryngology, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan
  • 2Department of Otolaryngology, PoJen General Hospital, Taipei, Taiwan
  • 3Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
JAMA Otolaryngol Head Neck Surg. 2016;142(11):1088-1093. doi:10.1001/jamaoto.2016.2114
Key Points

Question  What are the results of endoscopic transcanal myringoplasty for repairing anterior perforations of the tympanic membrane?

Findings  In this medical record review that included 59 patients undergoing endoscopic transcanal myringoplasty, 55 (93%) had successful graft repair at 6 postoperative months.

Meaning  Endoscopic transcanal myringoplasty should be considered for repairing anterior perforations of the tympanic membrane.

Abstract

Importance  Repairing anterior perforations of the tympanic membrane has been challenging for otolaryngologists. Therefore, devising a simple and effective technique for performing the repair is crucial.

Objective  To assess the results of endoscopic transcanal myringoplasty for repairing anterior perforations of the tympanic membrane.

Design, Setting, and Participants  This medical record review included 59 patients who underwent endoscopic transcanal myringoplasty from January 1, 2013, to June 1, 2015, at PoJen General Hospital, Taipei, Taiwan. Patients with ossicular chain disease and cholesteatoma or inadequate follow-up were excluded. Patients were followed up for 6 months, and final follow-up was completed on January 1, 2016.

Main Outcomes and Measures  The main outcome was the rate of overall graft success after endoscopic transcanal myringoplasty. Secondary outcomes included hearing results and prognostic factors.

Results  The study sample included the medical records of 59 patients (30 men [51%]; 29 women [49%]; mean [SD] age, 49.5 [13.1] years) who underwent endoscopic transcanal myringoplasty. Overall, 55 patients (93%) had a successful graft at 6 postoperative months. The mean (SD) preoperative and postoperative air-bone gaps were 15.9 (9.4) and 5.4 (7.0) dB, respectively, revealing a significant mean (SD) improvement of 10.3 (7.6) dB (Cohen d, 1.27; 95% CI, 0.90-1.63; P < .001, paired t test) in the gap. The postoperative air-bone gap in 46 patients (78%) was less than 10 dB; in 12 patients (20%), 10 to 20 dB; and in 1 patient (2%), more than 20 dB. Postoperative otorrhea significantly affected the graft success rate (odds ratio, 52.00; 95% CI, 4.08-662.55; P < .01, χ2 test). The visualization of the perforation margin (complete or partial) was not significantly associated with the graft success rate. However, partial visualization of the perforation margin significantly prolonged the mean (SD) operative time (complete vs partial, 59.2 [13.7] vs 68.1 [14.1] minutes; Cohen d, 0.64; 95% CI, 0.12-1.18; P = .02, t test).

Conclusions and Relevance  The rate of graft success and hearing outcomes for endoscopic transcanal myringoplasty are comparable with those of microscopic myringoplasty for repairing anterior perforations of the tympanic membrane. However, the present technique is simpler because postauricular incision, canalplasty, and general anesthesia are not required. Thus, endoscopic transcanal myringoplasty should be considered for repairing anterior perforations of the tympanic membrane.

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