Efficacy Analysis Of Endoscopic Tympanoplasty In The Management Of Tympanosclerotic Ossicular Chain Lesions

ObjectiveWe analyzed the effectiveness and safety of endoscopic tympanoplasty for the treatment of tympanosclerosis in the presence of ossicular lesions,and provided a reference for the selection of surgical modality by combining the typology of tympanosclerosis and its clinical characteristics.Methods and materialsRetrospective analysis of 1340 patients with a diagnosis of chronic suppurative otitis media and surgical treatment from 2016-01 to 2022-09 at the Center for Otolaryngology,Head and Neck Surgery,Zhujiang Hospital,Southern Medical University,with the following inclusion criteria(the following conditions must also be met):1.In our hospital,a tympanoplasty was performed,and intraoperative exploration revealed a lesion in the ossicular chain leading to fixation or restriction of movement of the auditory chain.2.Complete preoperative audiological and imaging data are available in our hospital case system,and HRCT examination of the temporal bone indicates a high-density shadow in the tympanic chamber with or without disruption of the ossicular chain;3.With or without other lesions such as middle ear granulation tissue or cholesteatoma;4.With or without tympanic membrane perforation due to previous history of chronic suppurative otitis media.Exclusion criteria:1,Patients who underwent endoscopic combined with microscopic surgery;2.Patients with incomplete preoperative clinical data and postoperative follow-up data;3.Patients with tympanosclerosis type I and simple tympanic membrane repair with lesions limited to the tympanic membrane;4.Patients who failed to cooperate with the follow-up.A total of 67 patients(73 ears)were included in this study.All 73 ears were divided into 18 ears in the microscopic surgery group and 55 ears in the endoscopic surgery group according to the surgical method.The differences in outcomes between the two groups were analyzed and compared,including:postoperative hearing changes,tympanic membrane healing effect and complications,operation time,length of hospital stay,operation cost and complications.The 73 ears included in this study were further divided into three subtypes according to the Wieling and Kerr tympanosclerosis typing criteria,including 30 ears of type Ⅱ(hamate fixation),5 ears of type Ⅲ(stapes fixation),and 38 ears of type Ⅳ(total tympanosclerosis);the hearing improvement and tympanic membrane healing effects of endoscopic tympanoplasty for each subtype of tympanosclerosis were analyzed and compared.In addition,the audiological characteristics and the effect of endoscopic surgery were futher analyzed in cases of ossified tympanosclerosis with new bone formation in the middle ear.The mean follow-up time after surgery was more than 3 months for all patients.All data were analyzed using SPSS 21.0 software,and P<0.05 was considered statistically different.OutcomeIn this study,67 patients(73 ears)with tympanosclerosis who met the inclusion criteria were divided into microscopic group(18 ears)and endoscopic group(55 ears)according to the surgical method;there was no statistical difference in the surgical time and length of hospital stay between these two groups(P=0.111,P=0.066,P>0.05),but the cost of surgery in the endoscopic group was less than that of microscopic surgery(ESS 7574.22±1270.86 vs.MSS 9001.78±1243.09),and the difference was statistically significant(P=0.000,P<0.05);the mean air-conduction hearing threshold(AC 51.76±17.89dBHL vs.39.18±17.98dBHL),mean boneconduction hearing threshold(BC22.07±14.22dBHL vs.18.22dBHL),and mean bone conduction hearing threshold in the endoscopic group before surgery compared with after surgery(P=0.000,P<0.05).14.22dBHL vs.18.22±13.28dBHL),and mean air-bone conduction difference(ABG 29.70±9.60dBHL vs.20.95±9.22dBHL)were statistically different(P<0.05);the mean air-conduction hearing threshold in the microscope group before surgery compared with after surgery(AC 53.61±12.47dBHL vs.40.900±16.34dBHL,P=0.05).16.34dBHL,P=0.000)and mean air-bone conduction difference(ABG 32.29±7.99dBHL vs.20.69±10.96dBHL,P=0.000)were statistically significant(P<0.05),but the mean bone conduction hearing threshold in the microscope group was not statistically significant(BC 21.32±10.14dBHL vs.20.21±10.22dBHL)compared with that in the preoperative and postoperative groups.10.22dBHL)was not statistically significant(P=0.575,P>0.05);there was no statistically significant difference in the pre-and postoperative comparison of the 8KHz air-conduction hearing threshold in the microscopy and endoscopic surgery groups(P>0.05).Based on the involvement of sclerotic foci,tympanic chamber sclerosis was divided into three groups:type Ⅱ,type Ⅲ,and type Ⅳ.Endoscopic analysis of the hearing indicators(AC,BC,ABG,8 KHz)related to tympanic chamber sclerosis type Ⅱ,type Ⅲ,and type Ⅳ revealed that the mean air-conduction hearing threshold(47.81±15.02 dBHL vs,36.15±20.00 dBHL),mean bone-conduction The mean airconduction hearing threshold(22.24±15.37 dBHL vs.18.700±14.18 dBHL)and the mean air-bone conduction difference(25.57±5.34 dBHL vs.17.44±7.93 dBHL)were statistically different before surgery compared to after surgery(P=0.000,P=0.005,P=0.000,P<0.05).(56.25±20.51 dBHL vs.40.65±16.21 dBHL),mean bone-conduction hearing threshold(22.50±14.29 dBHL vs.18.10±13.23 dBHL),and mean air-bone conduction difference(33.75±11.42 dBHL vs.22.55±9.14 dBHL)were statistically different preoperatively compared with postoperatively(P=There was no statistical difference in the mean air-conduction hearing threshold,mean bone-conduction hearing threshold,and mean air-bone conduction difference(P=0.785,P=0.699,P=0.305,P>0.05)between preoperative and postoperative for Type Ⅲ;there was no statistical difference in the high-frequency air-conduction hearing threshold at 8 KHz between preoperative and postoperative for Type Ⅱ,Type Ⅲ,and Type Ⅳ.There were no statistical differences compared with each other(P=0.600,P=0.752,P=1.000,P>0.05).There was no statistical difference in the improvement of hearing indexes(△AC,△BC,△8KHz)between the three groups of endoscopic tympanosclerosis type Ⅱ type Ⅲ and type IV after surgery(P=0.053,P=0.746,P=0.909,P>0.05).There was a statistical difference in the mean air-bone conduction difference hearing threshold improvement values(AABG:8.13±9.77,-4.19±6.78,11.20±12.91)compared to the three groups(P=0.045,P<0.05),and multiple analysis between groups:there was a statistical difference between tympanosclerosis type Ⅲ compared to tympanosclerosis type Ⅱ and Ⅳ(P=0.049、P=0.014,P<0.05).The hearing improvement rate of endoscopic tympanoplasty for tympanosclerosis type Ⅱ was 62.5%(15/24);the hearing improvement rate of tympanosclerosis type Ⅳ was 59.3%(16/27).There was no statistical difference in the mean operative time,mean length of hospital stay,and mean operative cost among the three groups of endoscopic tympanoplasty type Ⅱ,type Ⅲ,and type Ⅳ(P=0.124,P=0.217,P=0.092,P>0.05),but the mean operative time for type Ⅱ was shorter than that for type Ⅲ and type Ⅳ.Clinically,we found that in some patients diagnosed with tympanosclerosis,new bone formation with ossicular chain fixation was seen in the tympanic chamber,which is referred to as the ossified type in this paper.Of the 73 ears included in this study,15 ears had new bone,including 7 ears with hammer anvil bone fixation and 8 ears with total auditory chain fixation.The hearing improvement rate of endoscopic tympanoplasty was 80%(4/5)in the osteosclerotic type(hammer anvil fixation)and 50%(2/4)in the osteosclerotic type(total ossicular chain fixation).There was no statistical difference in the preoperative hearing indexes(PreAC,PreBC,PreABG,Pre8KHz)between tympanosclerotic type Ⅱ and ossified type(hammer anvil fixation)(P=0.676,P=0.855,P=0.578,P=0.876,P>0.05);preoperative hearing indexes between type Ⅳ and ossified type(total ossicular chain fixation)(PreAC,PreBC,PreABG,Pre8KHz)were not statistically different(P=0.673,P=0.435,P=0.083,P=0.106,P>0.05).Analysis of the relevant hearing indicators(AC,BC,ABG,8 KHz)in the two groups of sclerotic ossified tympanic chamber(hammer anvil fixation)and ossified(total ossicular chain fixation)revealed that the mean airconduction hearing threshold(46.25±7.95 dBHL vs.31.25±4.15 dBHL)and the mean bone-conduction hearing threshold(22.25±5.82 dBHL vs.15.00±5.59 dBHL)were statistically different preoperatively compared with postoperatively(P=0.018,P=0.015,P<0.05);mean air-bone conduction difference and high frequency air conduction hearing threshold 8 KHz were not statistically different preoperatively compared with postoperatively(P=0.125,P=0.804,P>0.05).The mean airconduction hearing threshold(57.19±22.67 dBHL vs.47.19±16.63 dBHL),mean bone-conduction hearing threshold(29.38±20.12 dBHL vs.26.25±21.91 dBHL),mean air-bone conduction difference(27.81±2.77 dBHL vs.20.94±7.39 dBHL),and mean air-bone conduction threshold 8KHz for the ossified type(full auditory chain fixation),and high frequency air conduction hearing threshold of 8 KHz(65.000±27.99 dBHL vs 70.000±24.83 dBHL)were not statistically different preoperatively compared with postoperatively(P=0.121,P=0.269,P=0.235,P=0.308,P>0.05).The mean operative time was shorter in the tympanosclerotic type Ⅱ than in the ossified type(hammer anvil fixation)(2.60±0.894h,1.78±0.67h,P=0.034,P<0.05).There was no statistical difference in the mean length of hospital stay,mean surgical cost,and mean surgical elapsed time between the two groups of tympanosclerotic ossification type(total auditory chain fixation)and type Ⅳ(P=0.654,P=0.077,P=0.958,P>0.05).Conclusion1.Endoscopic tympanoplasty is comparable to microscopic surgery in terms of postoperative efficacy and complications in the management of tympanosclerotic ossicular chain lesions,with better and safer postoperative hearing recovery.2.Hearing improved significantly after endoscopic tympanoplasty for tympanosclerosis type Ⅱ and Ⅳ,but hearing improved less after type Ⅲ than type Ⅱand Ⅳ.3.In tympanic sclerosis type Ⅱ and Ⅳ,the presence of new bone in the middle ear did not aggravate preoperative hearing loss,and the postoperative hearing improvement effect was comparable,but the operation took a long time,which provided a basis for the postoperative efficacy of tympanic ossclerosis ossification.