Myringotomy and Transtympanic Ventilation Tube Positioning

Myringotomy and ventilation tube placement are procedures usually indicated for middle ear effusion with persistent conductive hearing loss. Although tympanostomy tube placement is a well-known technique and is considered a simple and low-risk procedure, sometimes there can be significant complications associated with this approach, like otorrhea, displacement of the device, and persistent perforation of the tympanic membrane. The two main advantages of the endoscopic approach for myringotomy and ventilation tube positioning are the possibility to work better in case of stenotic or tortuous external auditory canal and the enhanced visualization that can allow us to identify vascular abnormalities medial to the tympanic membrane, avoiding critical complications. Compared to the human, the procedure in the ovine model is harder since the external auditory canal has a relatively small size and the pars flaccida has a wider extension, covering the middle ear landmarks and determining some technical troubles in inserting the ventilation tube due to the elasticity of the pars flaccida. Nevertheless, surgical gestures on the ovine model are very similar to those in the human, especially during ventilation tubes insertion phase. Therefore, thanks to the training on this ex-vivo model the surgeon can gain confidence and improve his skills also for human live surgery.