Professional video on Endoscopic Tympanoplasty

Comprehensive Video on Underlay Endoscopic Tympanoplasty for Left Ear by Dr Akbar Abbas ENT specialist. In this video, Dr Akbar focuses on the technique of underlay endoscopic tympanoplasty for the left ear.

Pre-operative Preparation

Prior to the procedure, the ear canal is infiltrated with two percent xylocaine with adrenaline from 12:00 to 6:00. The examination reveals a medium-sized, evenly-placed perforation surrounding the canal. The opening of the Eustachian tube appears clear.

Margin Refreshing and Considerations

To begin, the margins of the perforation are refreshed by removing inwardly grown epithelium using a straight pick. It is important to note some key considerations when performing an endoscopic tympanoplasty.

Straightening the Angulated Canal

In cases where the canal is angulated, a suture with silk through the concha can be used to straighten it. This maneuver involves pulling the concha backwards to facilitate easy insertion of the endoscope.

Incision and Hemostasis

The U mark, indicating the end of the external auditory canal, is identified prior to making a big slanting C-shaped incision. Starting at 11:00 superiorly and curving backwards towards 7:00, this incision ensures a clear visual field through the endoscope. Minimal bleeding is expected due to the earlier infiltration. Adeline-soaked cottonoids are used to control any bleeding and elevate the tympanic membrane and tympanomeatal flap.

Visualization and Examination

With the endoscope, the Quadrantanopia, incudostapedial joint, and round window are clearly visualized. The posterior recess capsule is opened using a 0-degree standard Hopkins rod to examine the ventilation pathways.

Dissection and Identification of Structures

The tympanic membrane is dissected away from the malleus, while the canal mark for the tensor tympani muscle is identified. The intact ossicular chain, including the stapedius tendon and surrounding structures such as the ponticulus subiculum and facial recess, are examined. The secondary membrane of the round window is also identified.

Graft Placement and Strengthening

Temporalis fascia from the temporal muscle is harvested and dried for ease of insertion into the tympanic space. Placed underneath the remnant of the tympanic membrane, the graft is inserted anteriorly up to the edge of the perforation. In some cases, a V-shaped cartilage is used to provide extra strength. Gel foam pieces are positioned to further secure the graft.

Final Verification and Post-operative Care

A final verification of graft placement is performed to ensure no gaps are present. The ear canal is filled with gel foam pieces for graft strength and hemostasis. The donor area is sutured, and patients typically do not require a head dressing post-procedure. Antibiotics are administered, and patients return for a post-operative check-up after one week.

Info: This is an informative and educational video for the benefit of medical students and patients who want to take informed decisions about health. The surgery was performed by Dr Akbar Abbas who is one of the best ENT specialist in Karachi, Pakistan. He specializes in otolaryngology, cochlear implants, ear surgery and is one of the few experts on pituitary and head and neck cancer surgery in Pakistan. Presently serving at Aga Khan University Hospital.