Transcanal Endoscopic Ear Surgery Outcomes, Learning Curves and Associated Factors: A Multivariate Analysis

By June 7, 2019

Fradeani, Dario1; Milner, Tom1; Iyer, Arunachalam1
1 Department of Otolaryngology, Monklands University Hospital, Airdrie, Scotland, United Kingdom.

to describe and analyse outcomes of Transcanal Endoscopic Ear Surgery (TEES) and its related surgical learning curve.

– Study Design: Prospective case study
– Setting: single tertiary care centre
– Patients: all the patients (290) that underwent ear surgery in 4 years period (2014-2017) since the introduction of TEES, with minimum 6 months follow-up; 150 females, 140 males; mean age 38 yy (5-77)
– Intervention (s): therapeutic.

– Main Outcome Measures: Comparative assessments of operative outcomes for tympanoplasty performed using a microscope, an endoscope or a combined procedure are discussed. Factors associated with successful outcomes for endoscopic tympanoplasty are determined using univariate and multivariate analyses.

Results: exponential increase in the use of TEES (48% to 79%). Rates of conversion from an endoscopic to a microscopic approach has halved (28% to 13%). TEES resulted in a learning curve of approximately 70 operations, with 91.4% having a successful perforation closure in the last third of patients analysed. Multivariate analyses showed that a smaller preoperative air-bone gap (ABG) is the only statistically significant factor for a healthy closure of a perforation following TEES (adj.OR=0.93, 95%CI=0.88-0.99, p=0.031). Factors associated with greater hearing gain post TEES tympanoplasty included a larger pre-operative ABG, lack of ossicle erosion (p=0.001), and use of tissue grafts (p=0.027).

Conclusion: TEES represents a relatively new technique that can result in similar outcomes to conventional microscopic surgery. A smaller preoperative ABG is correlated with successful perforation closure following surgery, while a greater hearing gain following surgery is associated with a larger pre-operative ABG, a lack of ossicle erosion and the use of autogenous tissue.