Endoscopic Transcanal Tympanoplasty Type I in Children: grafts and techniques

By June 7, 2019

Nassif, Nader1; di Zinis, Redaelli1; Oscar, Luca1
1 Department of Pediatric Otolaryngology – Head and Neck Surgery, Spedali Civili di Brescia, Brecia, Italy.

Endoscopic trancanal tympanoplasty type I (ETCT) is gradually diffusing internationally. It allows less invasive surgery in children with respect to microscope technique by avoiding the postauricular approach. Factors such as grafting choice and technique are still under discussion in order to obtain better results.

Between January 2011 and July 2018, results of prospective non randomized series of consecutive ETCT were analyzed in a tertiary referral center. Grafts used was autologous tragus perichondrium (TP) or non-autologous acellular porcine small intestinal submucosa (SIS). Underlay technique used in all cases with graft positioned either medial or lateral to malleus. Data inculded children suffering only from perforation in chronic otitis media with no prior surgeries and other pathologies.

101 children, age ranging 4 to 18 years, 59 males and 42 females, were eligible for the study. Follow-up ranging 6 to 78 months. TP and SIS were used in 62% and 38%, respectively. Total graft-intake was 80.2%; TP and SIS were 88.9% and 65.8% (P=0.005 SPSS), respectively. The medial and lateral graft-intake rate was 78.6% and 88.2% (P=0.4), respectively. Comparing graft intake w.r.t. age between 4 and 6 years and seven and above was 81.8% and 79.4% (P=0.7), respectively. All procedures were completed endoscopically without need to convert to microscope technique.

ETCT is a less invasive technique in children with respect to microscope. The use of SIS contributes additional less invasiveness to endoscope surgery by avoiding tragus harvesting. Graft-intake with TP, accorrding to our preliminary results, offer significantly better results than SIS. Graft positioned medial or lateral to malleus and age under or above 7 years do  not sigmificantly influence the outcome.