RESUMO
PURPOSE: Type I tympanoplasty is one of the first operations to be performed by ear surgeons in training and is increasingly performed using the endoscopic technique. The aim of the present study is to assess and compare the learning curve for type I tympanoplasties between a microscopically trained and endoscopic native ear surgeon. We hypothesize comparable learning curves between the two surgeons regardless of previous microscopic experience. METHODS: Retrospective analysis and comparison of the 25 first consecutive cases of type I tympanoplasty performed by a microscopically trained ear surgeon (MTES) and a native endoscopic ear surgeon (NEES). RESULTS: Mean duration of surgery in MTES and NEES groups was 54 ± 12.3 min and 55.6 ± 17.5 min, respectively. Both surgeons achieved a reduction of the surgery duration over time with statistically significant reduction from the first five cases to the last five cases in both groups. Graft intake rate was 92% after 3 months. Preoperative and postoperative PTA revealed a mean improvement of air bone gap (ABG) of 11.5 ± 7.1 dB HL in MTES group versus 9.3 ± 8.5 dB HL in NEES group, whereby the difference between the two groups was not statistically significant. CONCLUSION: Endoscopic type I tympanoplasty shows comparable results and learning curves in two beginning endoscopic ear surgeons independent of the previous microscopic experience. We recommend if available the parallel learning of both techniques.
Assuntos
Curva de Aprendizado , Cirurgiões , Humanos , Miringoplastia , Estudos Retrospectivos , Resultado do Tratamento , TimpanoplastiaRESUMO
Abstract Introduction Previous reports indicated that middle ear surgery might partially improve tinnitus after surgery. However, until now, no influencing factor has been determined for tinnitus outcome after middle ear surgery. Objective The purpose of this study was to investigate the association between preoperative air-bone gap and tinnitus outcome after tympanoplasty type I. Methods Seventy-five patients with tinnitus who had more than 6 months of symptoms of chronic otitis media on the ipsilateral side that were refractory to medical treatment were included in this study. All patients were evaluated through otoendoscopy, pure tone/speech audiometer, questionnaire survey using the visual analog scale and the tinnitus handicap inventory for tinnitus symptoms before and 6 months after tympanoplasty. The influence of preoperative bone conduction, preoperative air-bone-gap, and postoperative air-bone-gap on tinnitus outcome after the operation was investigated. Results and conclusion The patients were divided into two groups based on preoperative bone conduction of less than 25 dB (n = 50) or more than 25 dB (n = 25). The postoperative improvement of tinnitus in both groups showed statistical significance. Patients whose preoperative air-bone-gap was less than 15 dB showed no improvement in postoperative tinnitus using the visual analog scale (p = 0.889) and the tinnitus handicap inventory (p = 0.802). However, patients whose preoperative air-bone-gap was more than 15 dB showed statistically significant improvement in postoperative tinnitus using the visual analog scale (p < 0.01) and the tinnitus handicap inventory (p = 0.016). Postoperative change in tinnitus showed significance compared with preoperative tinnitus using visual analog scale (p = 0.006). However, the correlation between reduction in the visual analog scale score and air-bone-gap (p = 0.202) or between reduction in tinnitus handicap inventory score and air-bone-gap (p = 0.290) was not significant. We suggest that the preoperative air-bone-gap can be a predictor of tinnitus outcome after tympanoplasty in chronic otitis media with tinnitus.
Resumo Introdução Relatos anteriores indicaram que a cirurgia no ouvido médio pode melhorar parcialmente o zumbido após a cirurgia. No entanto, até agora, nenhum fator influenciador foi determinado para o resultado do zumbido após cirurgia de ouvido médio. Objetivo O objetivo deste estudo foi investigar a associação entre o gap aéreo-ósseo pré-operatório e o desfecho do zumbido após timpanoplastia do tipo I. Método Setenta e cinco pacientes com zumbido, com mais de 6 meses de sintomas de otite média crônica no lado ipsilateral que eram refratários ao tratamento médico foram incluídos nesse estudo. Todos os pacientes foram avaliados através de otoendoscopia, audiometria tonal/vocal, questionário utilizando a escala visual analógica e o questionário tinnitus handicap inventory para sintomas de zumbido antes e 6 meses após a timpanoplastia. A influência da condução óssea pré-operatória, gap aéreo-ósseo pré-operatório e pós-operatório sobre o desfecho do zumbido após a operação foi analisada. Resultados e conclusão Os pacientes foram divididos em dois grupos com base na condução óssea pré-operatória de menos de 25 dB (n = 50) ou mais de 25 dB (n = 25). A melhora do zumbido pós-operatória em ambos os grupos mostrou significância estatística. Pacientes com gap aéreo-ósseo pré-operatório inferior a 15 dB não apresentaram melhora no zumbido pós-operatório utilizando a escala visual analógica (p = 0,889) e o tinnitus handicap inventory (p = 0,802). Entretanto, pacientes com gap aéreo-ósseo pré-operatório maior do que 15 dB apresentaram melhoria estatisticamente significante no zumbido pós-operatório com a escala visual analógica (p < 0,01) e o tinnitus handicap inventory (p = 0,016). A mudança pós-operatória no zumbido mostrou significância em comparação com o zumbido pré-operatório usando a escala visual analógica (p = 0,006). No entanto, a correlação entre a redução no escore da escala visual analógica e gap aéreo-ósseo (p = 0,202) ou entre a redução no escore do tinnitus handicap inventory e gapaéreo-ósseo (p = 0,290) não foi significativa. Sugerimos que o gapaéreo-ósseo pré-operatório possa ser um preditor de desfecho do zumbido após timpanoplastia em otite média crônica com zumbido.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Otite Média/cirurgia , Zumbido/reabilitação , Timpanoplastia , Audiometria de Tons Puros , Zumbido/etiologia , Doença Crônica , Estudos Retrospectivos , Resultado do Tratamento , Período Pré-OperatórioRESUMO
INTRODUCTION: Previous reports indicated that middle ear surgery might partially improve tinnitus after surgery. However, until now, no influencing factor has been determined for tinnitus outcome after middle ear surgery. OBJECTIVE: The purpose of this study was to investigate the association between preoperative air-bone gap and tinnitus outcome after tympanoplasty type I. METHODS: Seventy-five patients with tinnitus who had more than 6 months of symptoms of chronic otitis media on the ipsilateral side that were refractory to medical treatment were included in this study. All patients were evaluated through otoendoscopy, pure tone/speech audiometer, questionnaire survey using the visual analog scale and the tinnitus handicap inventory for tinnitus symptoms before and 6 months after tympanoplasty. The influence of preoperative bone conduction, preoperative air-bone-gap, and postoperative air-bone-gap on tinnitus outcome after the operation was investigated. RESULTS AND CONCLUSION: The patients were divided into two groups based on preoperative bone conduction of less than 25dB (n=50) or more than 25dB (n=25). The postoperative improvement of tinnitus in both groups showed statistical significance. Patients whose preoperative air-bone-gap was less than 15dB showed no improvement in postoperative tinnitus using the visual analog scale (p=0.889) and the tinnitus handicap inventory (p=0.802). However, patients whose preoperative air-bone-gap was more than 15dB showed statistically significant improvement in postoperative tinnitus using the visual analog scale (p<0.01) and the tinnitus handicap inventory (p=0.016). Postoperative change in tinnitus showed significance compared with preoperative tinnitus using visual analog scale (p=0.006). However, the correlation between reduction in the visual analog scale score and air-bone-gap (p=0.202) or between reduction in tinnitus handicap inventory score and air-bone-gap (p=0.290) was not significant. We suggest that the preoperative air-bone-gap can be a predictor of tinnitus outcome after tympanoplasty in chronic otitis media with tinnitus.