Author(s)
Joshua T. Blotter MS
Geoffrey C. Casazza MD
Hilary C. McCrary MD
Albert H. Park MD
Affiliation(s)
University of Utah
Abstract:
Educational Objective: At the conclusion of this presentation, the participants will be informed of the anteriorly based tympanomeatal flap for the management of anterior tympanic membrane perforations. Objectives: Compare outcomes of a standard microscopic assisted tympanoplasty to a novel endoscopic technique with creation of an anteriorly based tympanomeatal flap. Study Design: Retrospective case control. Methods: Results of microscopic and endoscopic tympanoplasty for management of anterior tympanic membrane perforations from a single surgeon were collected. Microscopic tympanoplasties were performed using either standard posterior inferior vascular strip incisions or lateral graft technique, whereas all endoscopic tympanoplasties were performed using an anteriorly based tympanomeatal flap. Results were compared using a Mann-Whitney U test and Chi-square analysis. Results: There were 28 patients in the microscopic group and 11 in the endoscopic group. The mean age was 6.53 in the microscopic and 11.21 in the endoscopic groups (p<0.001). There was no statistically significant difference in perforation etiology (p=0.98), perforation location (p=0.63), or perforation size (p= 0.86) between the two groups. Mean operating room time was 112.9 minutes and 118.5 minutes in the microscopic and endoscopic groups respectively (p=0.73). The perforation was successfully closed in 11 patients in the endoscopic group (100%) and 24 in the microscopic group (85.7%), p=0.31. Postoperative improvement in air conduction four frequency pure tone averages was noted in both the microscopic (31.4dB to 22.6dB; p=0.007) and the endoscopic (31.9dB to 21.2dB; p=0.021). There were no complications in either group. Mean followup was 160 days and 511 days in the endoscopic and microscopic groups respectively. Conclusions: The anteriorly based tympanomeatal flap is a novel technique for management of anterior tympanic membrane perforations. This technique is a viable alternative to a standard approach.