Endoscopic tympanoplasty with limited tympanomeatal flap elevation in pediatric cases: comparison of anatomic and audiological results of grafts

  • Alper ŞenEmail author
  • Kadir Özdamar



The anatomical and functional success rates of tragal cartilage perichondrium and temporal muscle fascia, in pediatric patients who underwent endoscopic type 1 tympanoplasty with limited tympanomeatal flap elevation, were compared.


In total, 35 pediatric patients (21 females, 14 males; mean age 11.0 ± 1.5 years; range 8–14 years) who underwent transcanal endoscopic type 1 tympanoplasty with limited elevation of the tympanomeatal flap were included in this study. Patients in group A received a tragal cartilage perichondrium graft and those in group B received a temporal muscle fascia graft. The groups were compared with respect to the pre- and postoperative air–bone gap (ABG) and tympanic membrane status.


The mean preoperative and postoperative ABG were 27.0 ± 9.2 and 9.0 ± 8.5 dB in group A, and 26.8 ± 8.8 and 11.6 ± 9.2 dB in group B, respectively. The group differences in pre- and postoperative ABG values were not significant (p = 0.882 and p = 0.417, respectively). However, in both groups, the postoperative ABG was significantly lower than the preoperative ABG (both p = 0.0001). The graft retention rate was 100% in group A and 88.2% in group B; the difference was not statistically significant (p = 0.134). There was also no statistically significant difference between the pre- and postoperative bone conduction values of the patients at 0.5, 1, 2, 3 or 4 kHz (all p > 0.05).


Our study demonstrated that in pediatric patients undergoing endoscopic tympanoplasty, both the tragal cartilage perichondrium and the temporal muscle fascia can be used successfully and safely as grafts in endoscopic type 1 tympanoplasty performed by limited tympanomeatal flap elevation.


Endoscopic tympanoplasty Pediatric Tympanomeatal flap Perichondrium Fascia 



This study did not receive external funding.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

The study was approved by the ethics committee of the same hospital (Ethical committee no: 05/11/2018-11-E.45058). The study was carried out in accordance with the Principles of the Declaration of Helsinki and Guideline for Good Clinical Practices. All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki Declaration and its later amendments, or comparable ethical standards.

Informed consent

Informed consent was not obtained from the patients in this study due to its retrospective design and the implementation of anonymisation procedures.


  1. 1.
    Yegin Y, Çelik M, Koç AK, Küfeciler L, Elbistanlı MS, Kayhan FT (2016) Comparison of temporalis fascia muscle and full-thickness cartilage grafts in type 1 pediatric tympanoplasties. Braz J Otorhinolaryngol 82(6):695–701CrossRefGoogle Scholar
  2. 2.
    Rizer FM (1997) Overlay versus underlay tympanoplasty. Part 1: histological review of the literature. Laryngoscope 107:1–25CrossRefGoogle Scholar
  3. 3.
    Zoellner F (1955) The principles of plastic surgery of the sound-conducting apparatus. J Laryngol Otol 69:567–569CrossRefGoogle Scholar
  4. 4.
    Wullstein HL (1953) Functional operations in the middle ear with split-thickness skin graft. Arch Otorhinolaryngol 161:422–435CrossRefGoogle Scholar
  5. 5.
    Yang T, Wu X, Peng X, Zhang Y, Xie S, Sun H (2016) Comparison of cartilage graft and fascia in type 1 tympanoplasty: systematic review and meta-analysis. Acta Otolaryngol 136(11):1085–1090CrossRefGoogle Scholar
  6. 6.
    Jalali MM, Motasaddi M, Kouhi A, Dabiri S, Soleimani R (2017) Comparison of cartilage with temporalis fascia tympanoplasty: a meta-analysis of comparative studies. Laryngoscope 127(9):2139–2148. CrossRefGoogle Scholar
  7. 7.
    Hunter JB, O'Connell BP, Rivas A (2016) Endoscopic techniques in tympanoplasty and stapes surgery. Curr Opin Otolaryngol Head Neck Surg 24(5):388–394. CrossRefGoogle Scholar
  8. 8.
    Khan MM, Parab SR (2016) Endoscopic cartilage tympanoplasty: a two-handed technique using an endoscope holder. Laryngoscope 126(8):1893–1898. CrossRefGoogle Scholar
  9. 9.
    Tseng CC, Lai MT, Wu CC, Yuan SP, Ding YF (2017) Learning curve for endoscopic tympanoplasty: initial experience of 221 procedures. J Chin Med Assoc 80(8):508–514. CrossRefGoogle Scholar
  10. 10.
    Doğan S, Bayraktar C (2017) Endoscopic tympanoplasty: learning curve for a surgeon already trained in microscopic tympanoplasty. Eur Arch Otorhinolaryngol 274(4):1853–1858CrossRefGoogle Scholar
  11. 11.
    Kaya I, Turhal G, Ozturk A, Gode S, Bilgen C, Kirazli T (2017) Results of endoscopic cartilage tympanoplasty procedure with limited tympanomeatal flap incision. Acta Otolaryngol 137(11):1174–1177CrossRefGoogle Scholar
  12. 12.
    Harugop AS, Mudhol RS, Godhi RA (2008) A comparative study of endoscope assisted myringoplasty and microscope assisted myringoplasty. Indian J Otolaryngol Head Neck Surg 60:298–302CrossRefGoogle Scholar
  13. 13.
    Ayache S (2013) Cartilaginous myringoplasty: the endoscopic transcanal procedure. Eur Arch Otorhinolaryngol 270:853–860CrossRefGoogle Scholar
  14. 14.
    Becvarovski Z, Kartush JM (2001) Smoking and tympanoplasty: implications for prognosis and the Middle Ear Risk Index (MERI). Laryngoscope 111:1806–1811CrossRefGoogle Scholar
  15. 15.
    Awad OG, Hamid KA (2015) Endoscopic type 1 tympanoplasty in pediatric patients using tragal cartilage. JAMA Otolaryngol Head Neck Surg 141(6):532–538. CrossRefGoogle Scholar
  16. 16.
    Cohen MS, Landegger LD, Kozin ED, Lee DJ (2016) Pediatric endoscopic ear surgery in clinical practice: lessons learned and early outcomes. Laryngoscope 126(3):732–738. CrossRefGoogle Scholar
  17. 17.
    Lade H, Choudhary SR, Vashishth A (2014) Endoscopic vs microscopic myringoplasty: a different perspective. Eur Arch Otorhinolaryngol 271(7):1897–1902. CrossRefGoogle Scholar
  18. 18.
    Applebaum EL, Deutsch EC (1986) An endoscopic method of tympanic membrane fluorescein angiography. Ann Otol Rhinol Laryngol 95:439–443CrossRefGoogle Scholar
  19. 19.
    Gerlinger I, Ráth G, Szanyi I, Pytel J (2006) Myringoplasty for anterior and subtotal perforations using KTP-532 laser. Eur Arch Otorhinolaryngol 263(9):816–819CrossRefGoogle Scholar
  20. 20.
    Dündar R, Kulduk E, Soy FK, Aslan M, Hanci D, Muluk NB et al (2014) Endoscopic versus microscopic approach to type 1 tympanoplasty in children. Int J Pediatr Otorhinolaryngol 78(7):1084–1089. CrossRefGoogle Scholar
  21. 21.
    Ghaffar S, Ikram M, Zia S, Raza A (2006) Incorporating the endoscope into middle ear surgery. Ear Nose Throat J 85(9):593–596CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology-Head and Neck Surgery, Medical FacultyHarran UniversityŞanlıurfaTurkey
  2. 2.Department of Otorhinolaryngology-Head and Neck SurgeryPrivate Lotus HospitalŞanlıurfaTurkey

Personalised recommendations