The Role of Microscopic Techniques in Performing Tympanoplasty in Children

Abstract

Tympanoplasty is a delicate microsurgery, surgery repairing an anatomical lesion of the middle ear, caused by suppuration of chronic otitis. The main direction of the study is to determine the efficacy of tympanoplasty under microscopic control preoperatively, during surgery and postoperatively. In the clinic of pediatric otorhinolaryngology, 220 tympanoplasties were performed in children aged 8 to 18 years in the period 1995 – 2010. For examining the affected ear was used the surgical microscope "Opton". During surgery it was used the retroauricular access, given the narrow ear canal and need to perform control antrotomy in children. The temporal fascia, previously taken above the operated ear, was used as a graft. The fibrous ring of the tympanum perforation edge was removed and the skin of the posterior wall of the external auditory canal with the tympanum ring and the posterior part of the tympanum were taken off. During operation, after a detailed microscopic examination of middle ear, it was planned the type of tympanoplasty. As support for the fascial graft was used the gelfoam applied in the middle ear. It was used the surgical technique ―”Underlay” or „Overlay”. Positive results after tympanoplasty using surgical microscope, characterized by integral neo tympanum, lack of exacerbations of the inflammatory process of the middle ear, were obtained in 83% of operated children, including 45% cases with the improvement of hearing. Microscopic control of the affected ear before, during and after surgery improves clearly the quality of microsurgical intervention, reduces the number of ear complications, improves hearing in children and reduces their invalidity.