TYMPANOSCOPE ASSISTED MYRINGOPLASTY

T Karhuketo, J Ilomaki, H Puhakka

Tampere University Hospital

Tampere, FINLAND

A new method to perform an endaural endoscopic myringoplasty with new features is described and the results are presented.

Thirty ears of 29 patients with different sized perforation of tympanic membrane were treated in Tampere University Hospital from 1995 to 1997. Endoscopes of 1,7 mm in diameter, 112-114 mm in length and with 0° , 30° and 90° angles of view were used.

Otomicroscopy as well as larger endoscopes do not allow a surgeon to intrude into the middle ear cavity through a tympanic membrane perforation to visualize if the epithelium possibly is migrating in the middle ear. With an unreported method of 90° (field of view 60° -120° , backward looking) endoscope the medial surface of tympanic membrane can be observed. The inspection and endoscopic extirpation of the epithelial migration during endoscopy justified the surgeon to proceed with tympanal fascial myringoplasty through perforation. Detachment of tympanic membrane was not required. The anterior perforations hidden due to the curved ear canal were also operated endaurally with the assistance of endoscopy.

We also used a "snake"-arm to hold a funnel immobilized in the ear canal. Angled instrumentation was developed for endaural tympanoscope assisted operation. The only necessary skin incision was to harvest a piece of fascia. The incision was hidden above the hairline. Esthetically no scar was seen postoperatively.

The graft take was 87 % in thirty cases. The cure in PTA, pure tone average, was 7 dB in average.