Comparison Of Clinical Efficacy Of Ear Endoscopic Type Ⅰ Tympanoplasty And Microscopic Type Ⅰ Tympanoplasty Under Ear Canal

Objective: to compare the clinical efficacy of endoscopic type I tympanoplasty and microscopic type I tympanoplasty under ear canal and to analyze the advantages and disadvantages of the two methods.Methods: 40 cases(40 ears)with chronic suppurative otitis media in our department from February 2018 to March 2019 were selected.All the patients in this retrospective study were chronic otitis media without cholesteatoma.All patients underwent detailed medical history inquiry,special examination of ear,nose,throat,head and neck,CT examination of middle ear and pure tone hearing examination.All the patients included in the study were divided into two groups: the endoscopic group was the type I tympanoplasty group under the endoscopic approach of the ear canal,and the microscopic group was the type I tympanoplasty group under the microscopic approach of the ear canal.The postoperative follow-up time was from 3 months to 1 year.Preoperative,the pure tone hearing threshold(mean value of 500 Hz,1000Hz and2000Hz)of the two groups of patients were collected including age,gender,operative ear,preoperative air conduction and air-bone gap.During the operation,the operation time,anesthesia method,blood loss and tympanic membrane transplantation materials of the two groups were collected.Postoperative discharge time,tympanic membrane healing,postoperative air conduction and air bone conduction were collected.SPSS21.0statistical software was used for clinical data analysis,t test was used for measurement data,rank sum test was used for grade data,and chi square test was used for count data.The difference at P<0.05 was statistically significant.Results:1.Comparison of surgical conditions between the two groups: compared with the microscopic group,the number of days of postoperative discharge in the endoscopic group was less than that in the microscopic group,and the difference between the two groups was statistically significant(P<0.05).There was no significant statistical difference in operative time and intraoperative blood loss between the two groups(P>0.05).2.Comparison of postoperative hearing improvement between the two groups: the average preoperative and postoperative air air conduction of the endoscopic group was40.8+9.9db and 22.7+6.2db,respectively.The preoperative and postoperative mean values of air-bone gap were 26.7+9.4db and 11.9+5.5db,respectively.The postoperative mean values of air conduction and mean values of air-bone gap were significantly lower than those before the surgery,and the difference was statistically significant(P<0.05).The preoperative and postoperative mean values of air conduction in the microscopic group were 45.5+14.9db and 26.2+10.1db,respectively.The mean value of air-bone gap before and after the operation was 29.0+12.0db and 13.8+7.7db,respectively.The mean value of air conduction and mean value of air-bone gap after the operation were significantly lower than that before the operation,and the difference was statistically significant(P<0.05).The decreased mean value of air conduction and decreased mean value of air-bone gap in endoscopic group were 17.6+6.7db and 14.6+7.7db,respectively.The decreased mean value of air conduction and the decreased mean value of air-bone gap in the microscopic group were 19.9+10.0db and 15.1+8.1db,respectively.There was no significant statistical difference between the two groups in the mean reduction of air conduction and the mean reduction of air-bone gap.3.Comparison of tympanic membrane healing rate and complication rate between the two groups: during the postoperative follow-up of 20 patients in each group,the tympanic membrane healed in the endoscopic group and in the microscopic group without perforation.There were no complications such as persistent external auditory canal pus,facial paralysis and hyposmia.Conclusion: the advantages and disadvantages of endoscope and microscope are the same.The field advantage of endoscope is the disadvantage of microscope,and the advantage of two-handed operation of microscope is the disadvantage of one-handed operation of endoscope.The cost of endoscopic equipment is lower,and it is more suitable for the use and popularization of basic hospitals.The results showed that there were no significant statistical differences in the operative time,blood loss and hearing improvement of type I tympanoplasty under endoscope and under ear canal microscope.The postoperative discharge days of the endoscopic group were slightly less than those of the microscopic group,and the difference was statistically significant.Both of the two surgical methods have the characteristics of small incision,small injury and quick recovery,and there is no significant statistical difference in clinical efficacy,which is easy to be accepted by patients.