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Endoscopic tympanoplasty for the repair of total tympanic membrane perforation following blast injury (with Video)

Perforations of the tympanic membrane by direct or indirecttrauma represent a typical finding for the practicing clinician. By its design, the ear is the first organ affected in a primary blastinjury. Blast pressure waves can perforate the tympanic membrane(TM), disrupt the ossicles, or cause permanent inner ear damage.Reported spontaneous healing rates of the TM after blast injuriesrange from 38% to 82% with size of perforation being the mostsignificant predictive factor. Most surgeons believe a period ofobservation for spontaneous healing is required. Tympanoplastyshould be performed if there is no sign of spontaneous improve-ment in a period of 3 months.ˇSprem et al. achieved success ratesof 90% for closing the tympanic membrane perforations in 172individuals with blast-induced TM perforations and there was nodifference in success rate based on the type of grafting material. Microscopic surgery through retroauricular incision has beenthe standard procedure for closing subtotal and total TM perfora-tions. In the last decade however, there has been an increased useof the endoscope in ear surgery, allowing surgeons to perform mostof the operations through the ear canal. By advancing the scopedirectly into the canal, thus passing behind the narrowest portionof it, we are not only avoiding external incisions but also getting awide magnified view of the TM with 4 K resolution. Pap et al. did ameta-analysis of efficiency of the endoscopic tympanoplasty versusthe microscopic and found no difference in closure rate of perfora- tions, with a significantly better cosmetic result in the endoscopicgroup.In this surgical demonstration, we are presenting endoscopictympanoplasty technique in a 38-year-old male, 3 months after ablast injury to the eardrum. Besides closing the total perforation, we had to deal with many adhesions and granulation tissue around theossicles, where the use of the endoscope showed all its advantage sallowing us high- definition view and working around the cornerswith ease. For the closure of the subtotal and total TMperforations, we routinely perform underlay tympanoplasty with acartilage- perichondrium composite island graft as described by Tos. By having the whole tympanic membrane in the surgical view, it is possible to precisely shape the graft and place it in an accurateposition regarding the bony annulus, even in theanterior part, thus preventing residual perforation and blunting ofthe anterior edge. The aim of this video presentation is to show that endoscopictympanoplasty offers superior quality image with avoidance of theexternal incisions, and as such should be offered as a treatmentof choice for closing all sizes of tympanic membrane perforations, regardless of etiology.

YO-IFOS ; IFOS ; endoscopic ear surgery ; tympanoplasty ; blast injury

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