Learning Objectives: Techniques for surgical treatment of LTM and MFF with TESS.

Introduction: The lateralized tympanic membrane (LTM) and medial meatal fibrosis (MMF) are conditions in which the visible surface of the tympanic membrane (TM) is located lateral to the bony annular ring. While the TM is out of position in each condition, the causes differ for the lateralization and the final position of the TM layers. Specifically the LTM loses contact with the ossicular chains while MMF is characterized by acquired atresia with fibrous tissue in the medial part of external auditory canal. Treatment of LTM and MMF presents challenges, in part due to difficulties in visualizing the affected site. Our unit has worked on developing a treatment protocol which incorporates and extends current treatment approaches as well as incorporates the use of the endoscope to achieve a less invasive approach with improved visualization of the affected site.

Methods: Transcanal endoscopic ear surgery (TEES) was used to treat both LTM and MFF using a rigid endoscope with an outer diameter of 2.7 mm coupled to a full HD system. A cross-shaped incision is made across the TM surface and four skin flaps are elevated to exposure the pathology. LTM is treated by removing the mucosa from the ear canal wall and grafting the TM perforation with fascia to the anterior part of tympanic annulus using the underlay technique. MFF is treated by removing the fibrous tissue from the bony ear canal and the TM lamina propria. The lamina propria and denuded bone is covered with split-skin grafts. Both conditions require canalplasty using a curved bur for complicated bony canal stenosis.

Results: Endoscopes allow for greater overall visualization which is a significant advantage in the surgical treatment of LTM and MMF particularly around the tympanic annulus.

Conclusions: Surgical treatment for LTM and MMF via TEES is an effective and less invasive procedure.