Endoscopic Tympanoplasty: The Fringed Shield Technique

Authors: Eduardo Machado Rossi Monteiro* , Lima Nascimento MF and Cangussu Brito TR

DOI: 10.23880/ooaj-16000235

Volume 7, Issue 2

Abstract

Introduction: Endoscopic tympanoplasty has become popular in the past few years. To reach anterior quadrants of the middleear for adequate graft setting and complete perforation closure, most surgeons detach the remaining tympanic membrane from the umbus. This maneuver may cause elevation of the anterior tympanomeatal angle and result in blunting and worse audiometric thresholds. Objectives: Describe a tympanoplasty endoscopic technique with a modified full thickness cartilage graft that allows its positioning without the need to detach the malleus handle from the tympanic membrane. Data Synthesis: Because endoscopic ear surgery is an one-handed procedure, the graft needs to be stiff and easy to manipulate to facilitate its positioning and complete closure of the tympanic perforation. We describe a full thickness tragal cartilage graft shaped as an oval island with a wedge to accommodate the malleus handle and with the anterior and posterior edges fringed. This design allows its positioning in an underlay technique without the need to detach the malleus handle from the tympanic membrane. Thereby, without this maneuver, it is possible to prevent blunting and, consequently, reduce the odds of hearing loss. Conclusion: The fringed shield technique is a promising endoscopic approach with good hearing results. Although the hearing outcomes presented in this paper are not exclusive for the fringed shield technique, we would not expect different results since we have applied full thickness cartilage graft in most cases. Nevertheless, a larger series of patients submitted exclusively to the fringed shield graft would be necessary to confirm these data.

Keywords: Tympanoplasty; Endoscope; Ear Cartilage; Tympanic Membrane Perforation; Otitis Media

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