Posterior Spine and Cholder Tympani: a Retrospective Analysis of 52 TEES Cases with Non-Perforated Tympanic Membrane

By June 7, 2019

Fujioka, Masato1; Suzuki, Narihisa1; Hosoya, Makoto1; Nishiyama, Takanori1; Noguchi, Masaru1; Kunihiro, Takanobu1 Kanzaki Sho1; Ogawa, Kaoru1
1 Department of Otolaryngology, Keio University School of Medicine, Tokyo, Japan

– Preserving cholder tympani is the first step for the TEES surgeons to learn. The objective of this study was to know the anatomical relationship in between cholder tympani and posterior spine, an easily identifiable landmark for the surgeon.

– Study Design: Retrospective case review
– Setting: Tertiary referral university hospital
– Patients: A sequential series of 52 cases (June 2016 – Jan 2019) performed TEES surgery meeting following criteria are included: 1) surgery for the first time, 2) with a non-perforated tympanic membrane before operation, 3) if both sides were operated, first operated ear was examined.
– Intervention: No additional intervention other than surgery.

– Main Outcome Measures: Surgery videos and pre-op CT scans were retrospectively reviewed. Anatomical relationship in between posterior spine and cholder tympani was documented in the video and CT in each case. Clinical features of individual cases were also chart reviewed.
– Results: In 47 cases (90.4 %), cholder tympani ran under the posterior spine. In 5 cases (9.6 %), cholder tympani rose in front of the posterior spine and run in between spine and tympanic membrane. Of 5 cases with cholder tympani running at the shallow side, pre-operative CT scan was performed in 4 of 5 cases and the positional relationship could be pointed out only 2 of 4 cases.

– In most cases the cholder tympani run behind the posterior spine but not in approximately 10 %. Pre-operative evaluation with CT scan may help surgeons to understand the location in half of them. The results suggest that the great care should be taken care of when the tympanomeatal flap was elevated in TEES in order to avoid from damaging cholder tympani.