Endoscopic Tympanoplasty: Experience in Uruguay

By June 8, 2019

Gratadoux, Camila1; Percovich, José1; Costas, Gustavo1
1 Department of Othorhinolaringology – Head and Neck Surgery, Hospital de Clínicas, University of the Republic, Montevideo, Uruguay.

We work in a high complexity university hospital in Uruguay (3.000.000 population), the Department of Otorrinolaryngology provides attention to over 6000 patients every year. In order to reduce waiting time, we perform procedures with local anesthesia on a regular basis. We found in endoscopic ear surgery, especially tympanoplasty, a way to give our patients an effective treatment with the resources available
Main purpose of this work: Present our outcomes in endoscopic tympanoplasty and our considerations about them

•Retrospective review of medical records
•June 2015 to July 2018

•Primary eligibility criteria:
a)Diagnosis of chronic perforation of the tympanic membrane
b)Endoscopic tympanoplasty
c)Post surgery follow up
d)Pure tone audiometry pre and post surgery.

•Patients with no follow-up were excluded

Surgical technique:
•Endocanal without tympanomeatal flap in perforations smaller than 50% of tympanic membrane
•Transcanal with tympanomeatal flap in perforations bigger than the 50% of tympanic membrane.

Graft: tragal cartilage and perichondrium
Injection of mepivacaine 2% + epinephrine in the external auditory canal was used in all cases

•81 surgeries in 75 patients, 4 excluded
•n=77 surgeries in 71 patients
•Mean age 39 y.o (15-72)​
•Female 73%, Male 29%
•Timpanomeatal Flap: With 13%, Without 87%
•Anesthesia: General 39%, Local 61%

•Graft: Incorporation 86%, Lateralization 14%
•Audiometry improvement: Yes 82%, No 18%

We found no statistically significant differences between our graft incorporation rate and the ones presented on literature

•Patients who suffer graft lateralization had surgery under local anesthesia and tolerated poorly the procedure
•Better selection of patients to undergo local anesthesia procedures, regardless institutional availability, is mandatory