Abstract
Background Simple closure of tympanic membrane perforation is not a successful myringoplasty.
It has to obey a lot of functional aspects of the middle ear cleft. Certain factors
play a role in failure cases. The endoscopic functional myringoplasty or tympanoplasty
is a clear visualization of all the parts of the middle ear; examination and removal
of the disease from the hidden parts of the middle ear, examination of inter-attico-tympanic
diaphragm; and removal of blocks, if any, in isthmus, to reestablish the gas exchange
pathways and finally preserve the middle ear mucosa at maximum to further restore
the ventilation.
Methods Endoscopic tympanoplasty was performed in 100 patients with large tympanic membrane
perforations and patent eustachian tube, using 4-mm “0” and “45” degree endoscopes
by proper visualization of the tympanic diaphragm and isthmus in every patient and
clearing its blockage if present.
Results Among the 100 patients, 78 had epitympanic diaphragm blockage at the level of isthmus,
5 patients were found with closed tensor tympani folds, both vertical and horizontal
without any ventilatory routes in them. Although in all the patients the eustachian
tube was patent, we found majority of them had a dysventilation at the level of the
epitympanic diaphragm. Thus, by performing endoscopic ventilatory pathway clearance
and tympanoplasty, we achieved 94% positive results.
Conclusion Epitympanic diaphragm is a functional barrier between upper and lower compartments
of the middle ear cleft, which play important role in the ventilation and partial
pressure regulation, blockage of its isthmus may lead to tympanic membrane retractions
and perforations. With the aid of endoscopes of various degrees, removing any pathological
blocks, recreating proper ventilation, reestablishing gas exchange mechanism, and
maximum preservation of normal mucosa for the gas exchange are the aims of an endoscopic
functional tympanoplasty procedure.
Keywords
epitympanic diaphragm - myringoplasty - tympanoplasty
