Background: Myringoplasty can be technically difficult in the pediatric patients due to the narrowness of the\nexternal auditory canal and the generally small size of the ear. Moreover, temporalis fascia grafts and myringoplasties\nfor anterior perforations are more likely to fail in children. Surgical management of anterior perforations requires total\nexposure of the anterior angle however a microscope may fail to provide a view of the anterior edge in most of\nperforations. Recently, different endoscopes are used in the performance of ear surgery in general and myringoplasty\nin particular. Current study aimed to investigate the outcome of transcanal microscope-assisted endoscopic\nmyringoplasty in homogenous group of children.\nMethods: The medical records of 22 children were retrospectively reviewed for age, perforation size and\nlocation, surgical and audiological findings, and outcome. All myringoplasties were performed by first author\nwith a chondro-perichondrial graft that has been harvested from the tragus and placed medial to the tympanic\nmembrane remnants, utilizing the underlay technique and 14-mm length, 3-mm diameter, 0Ã?° and 30Ã?° endoscopes. A\nmicroscope was occasionally used for removal of the sclerotic plaques and releasing adhesions surrounding the ossicles\nwhen bimanual manipulations were needed. Surgical success was defined as a tympanic membrane with no\nperforation, retraction, or graft lateralization for at least 18 months following surgery.\nResults: Thirteen large-, 8 medium- and 1 small-sized perforations (defined as 75, 50 or 25%, respectively, of the\ntympanic membrane area), of which 14 were anterior, 2 central and 6 posterior marginal, were repaired. The edges\nof the defect could not be visualized under a microscope due to bone overhanging or a curved or narrow EAC in\n8 anterior perforations. Intact tympanic membranes and dry ears were achieved in all operated children. The audiometric\nair conduction level (average of 0.5-3 kHz) for the entire cohort ranged between 10ââ?¬â??51.3 dB (mean 32.8) preoperatively\nand between 5ââ?¬â??35 dB (mean 18.2) postoperatively.\nConclusion: The transcanal microscope-assisted endoscopic myringoplasty had a 100% rate of surgical success in\nchildren. This technique can be especially appropriate for patients with narrow external canals, anterior defects and\nbone overhang making the perforation margins barely visible under a microscope.
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