Endoscopic Optical Coherence Tomography for Evaluation of Success of Tympanoplasty

OBJECTIVE After tympanoplasty, it is often challenging to differentiate between different causes of a remaining air bone gap (ABG). Optical coherence tomography (OCT) offers a new approach for combined morphologic and functional measurements of the tympanic membrane and adjacent parts of the middle ear. Thus, it provides valuable diagnostic information in patients with a reduced sound transfer after middle ear surgery. PATIENT AND INTERVENTION A patient with history of tympanoplasty and a persistent ABG was investigated with endoscopic OCT before revision surgery. MAIN OUTCOME MEASURES The oscillation behavior and the thickness of the reconstructed tympanic membrane was determined. The oscillation amplitudes of the inserted prosthesis were compared to a finite element model simulation and to the clinical findings and the audiometric data of the patient. RESULTS OCT measurements showed a reduced oscillation amplitude of the prosthesis while revealing an aerated middle ear and good coupling of the prosthesis. Transfer loss measured by OCT showed a similar progression as the ABG measured by pure-tone audiometry with a mean divergence of 4.45 dB. CONCLUSION Endoscopic OCT is a promising tool for the evaluation of tympanoplasty outcome. It supports established otologic diagnostics and can help differentiating between different causes of conductional hearing loss.