Learning curve for endoscopic tympanoplasty type I: comparison of endoscopic-native and microscopically-trained surgeons
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OTOLOGY
Learning curve for endoscopic tympanoplasty type I: comparison of endoscopic‑native and microscopically‑trained surgeons Eduardo Machado Rossi Monteiro1 · Sven Beckmann2 · Maísa Mendes Pedrosa1 · Till Siggemann2 · Sarah Maciel Augusta Morato1 · Lukas Anschuetz2 Received: 5 May 2020 / Accepted: 13 August 2020 © The Author(s) 2020
Abstract 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. Keywords Endoscopic ear surgery · Endoscopic tympanoplasty · Tympanoplasty type I · Learning curve
Introduction With the spread of endoscopic ear surgery (EES) in the last three decades, the endoscopic approach to type I tympanoplasty has gained increasing attention. The first endoscopic transcanal myringoplasty in humans was described in 1992 by El Guindy et al. [1], followed by the first cohort of endoscopic tympanoplasties in 1999, demonstrating similar Eduardo Machado Rossi Monteiro and Sven Beckmann contributed equally first authors. * Sven Beckmann [email protected] 1
Department of Otorhinolaryngology, Hospital Felicio Rocho, Belo Horizonte, Brasil
Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Freiburgstrasse 16, 3010 Bern, Switzerland
2
results compared to conventional microscopic approaches [2]. More recently, systematic reviews and meta-analyses found similar functional, hearing and safety results for endoscopic compared to microscopic tympanoplasty. However, a lower rate of canaloplasty, fewer wound complications, shorter operative times and higher cosmetic satisfaction was described for EES [3–5]. Furthermore, patients undergoing
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