A Prospective Study Comparing the Results of Endoscope Assisted Versus Microscope Assisted Myringoplasty

Objective: To assess the operative time, post operative pain, graft uptake and audiological gain in the group of the patients undergoing the endoscope assisted and the microscope assisted myringoplasty. Setting: Tertiary referral hospital. Subjects: The study was prospective in nature and comprised of 100 patients suffering from the chronic otitis media inactive mucosal disease. Patients attending the Otorhinolaryngology out patients department were included in this study. Methods: Transcanal myringoplasty or type-1 tympanoplasty was performed by either the endoscope or the microscope assistance. Endaural/Postaural approach was undertaken in few microscope assisted myringoplasty. Underlay technique of myringoplasty was performed using temporalis fascia graft in all the patients suffering from the inactive mucosal chronic otitis media. Post operative evaluation was done in terms of operative time, pain, graft uptake and audiological gain. The patients were followed up for a period of 6 months. Results: The operative time in the patients undergoing the endoscope assisted myringoplasty was 49.76±3.18 minutes whereas it was 62.37±3.69 minutes in the patients undergoing the microscope assisted Transcanal myringoplasty and 72.15±2.56 minutes in the patients undergoing the microscope assisted Endaural/Postaural myringoplasty. Post operative pain was assessed the next day after the surgery, it was less severe in the Transcanal approach endoscope/microscope assisted myringoplasty groups and more severe in the microscope assisted Endaural/Postaural approach myringoplasty group. The difference between the groups was statistically significant. The tympanic membrane graft uptake and audiological gain was assessed at 1 month, 3months and 6 months post operatively. The successful closure of the tympanic membrane perforation was higher with the endoscope assisted myringoplasty as compared to the microscope assisted myringoplasty at 1 month, 3 months and 6 months of follow up but the difference was not statistically significant. The mean audiological gain following myringoplasty with both the techniques used was noted. The mean audiological gain was found to be marginally better with the endoscope assisted myringoplasty at follow up of 1, 3 and 6 months as compared to the microscope assisted myringoplasty, however this difference was not statistically significant. Conclusion: The operative time was less in the endoscope assisted technique as compared to the microscope assisted technique. The post operative morbidity (evaluated in terms of post operative pain) was less in the group of patients undergoing the Transcanal endoscope assisted as compared to microscope assisted myringoplasty. The post operative pain was more severe in the Endaural/Postaural approach than the Transcanal approach microscope assisted myringoplasty. There was no statistically significant difference in either graft uptake or post-operative audiological gain in the patients undergoing myringoplasty by endoscope assisted and microscope assisted technique. The endoscope assisted myringoplasty has advantages of better assessment of ossicular chain and in the patients with canal overhang it improves the visualisation of the margins of the perforation thus obviating the need for canalplasty. Thus the endoscope assisted myringoplasty can be used as a preferred alternative to the conventional microscope assisted myringoplasty, with better post operative results and reduced operating time and morbidity of the surgical procedure.