Ventilation Pathways of Middle Ear and Mastoid in Patients Undergoing Endoscopic Tympanoplasty at a Tertiary Care Center in Uttarakhand: An Observational Study

Background Chronic otitis media (COM) is one of the most common diseases causing hearing impairment. Tympanoplasty is the treatment of choice for patients suffering from a mucosal type of COM. The success of tympanoplasty depends on many factors, including the ventilation pathways of the middle ear and mastoid, which can be visualized using an endoscope. Aim The aim of the study is to evaluate the ventilation pathways of the middle ear and mastoid in patients undergoing endoscopic tympanoplasty. Methodology It was an observational cross-sectional study conducted in the Department of Otorhinolaryngology - Head and Neck at a tertiary care center in North India from August 2022 to January 2024. Around 64 patients aged 18-50 years, suffering from inactive mucosal type of COM, were included in the study. Preoperative hearing assessment was performed. All patients underwent endoscopic tympanoplasty under general anesthesia. Intraoperative visualization and documentation of the ventilatory pathways of the middle ear and mastoid were performed using 0-degree and angled endoscopes. The patients were evaluated for the outcome of surgery at 4 weeks and 12 weeks in terms of graft uptake and postoperative hearing benefit. Results A total of 64 patients underwent transcanal endoscopic tympanoplasty in our study. Intraoperative visualization of ventilation pathways through rigid angled endoscope revealed that 55 patients (86 %) had clear anterior and posterior isthmus. Nine patients (14%) had blocked ventilation pathways, which were cleared during surgery. Graft uptake was successful in 63 patients (98.4%). The mean hearing threshold improvement was statistically significant. Conclusion Transcanal endoscopic tympanoplasty using a rigid angled endoscope has the advantage of visualizing the ventilation pathways and middle ear spaces through a single approach, avoiding mastoid exploration. Evaluation of the middle ear ventilation pathways during tympanoplasty can give good surgical results in terms of graft uptake and hearing improvement, as it ensures good ventilation between various compartments of the middle ear cleft.