{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T21:07:02Z","timestamp":1773868022263,"version":"3.50.1"},"reference-count":0,"publisher":"Caleo","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Int Adv Otol."],"abstract":"<jats:p>BACKGROUND: To characterize the workflow during transcanal totally endoscopic tympanoplasty by recording the time and instrumentation\u00a0used for different steps in the procedure. This analysis aims to identify aspects of instrumentation and surgical technique that could be modified\u00a0to improve surgical efficiency.\n\nMETHODS: Thirty-one endoscopic tympanoplasty procedures were observed at a single academic center. Patient age ranged from 2.7 to\u00a017.8 years. The procedure was separated into distinct steps. The duration in minutes and the instruments used were recorded by an independent\u00a0observer.\n\nRESULTS: Raising the tympanomeatal flap (median 9.82 minutes) and positioning the graft and replacing the flap (median 9.13 minutes) took significantly\u00a0longer than all other steps (P &lt; .05, Wilcoxon method). Teaching a trainee significantly increased step duration by a total of 32.8 minutes\u00a0(P &lt; .05, Wilcoxon method). There was no correlation between age of the patient, side of the ear, surgical technique, or graft type, and duration\u00a0of surgery. Suction instruments with a functional tip (dissector or knife tip) were most commonly used to dissect and maneuver soft tissue while\u00a0maintaining the surgical field clear of blood.\n\nCONCLUSION: As elevation of the tympanomeatal flap and graft placement are the most time-consuming steps in endoscopic tympanoplasty,\u00a0especially for surgical trainees, surgical efficiency could most dramatically be enhanced by modification of instrumentation or technique to facilitate\u00a0these steps. Modification of simpler steps such as hair trimming and ear canal packing have less potential for shortening surgical duration.\n\nCite this article as: Swarup A, Chayaopas N, W. Eastwood K, James A. Time flow study to assess opportunities to improve efficiency in endoscopic\u00a0tympanoplasty. J Int Adv Otol. 2021; 17(4): 288-293.<\/jats:p>","DOI":"10.5152\/iao.2021.9232","type":"journal-article","created":{"date-parts":[[2021,7,16]],"date-time":"2021-07-16T09:18:34Z","timestamp":1626427114000},"page":"288-293","source":"Crossref","is-referenced-by-count":2,"title":["Time Flow Study to Assess Opportunities to Improve Efficiency in Endoscopic Tympanoplasty"],"prefix":"10.65717","volume":"17","author":[{"given":"Arushri","family":"Swarup","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nichtima","family":"Chayaopas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyle W.","family":"Eastwood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian","family":"James","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"55248","published-online":{"date-parts":[[2021,7,1]]},"container-title":["The Journal of International Advanced Otology"],"original-title":[],"link":[{"URL":"https:\/\/www.advancedotology.org\/index.php\/pub\/article\/download\/1504\/1502","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.advancedotology.org\/index.php\/pub\/article\/download\/1537\/1534","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.advancedotology.org\/index.php\/pub\/article\/download\/1537\/1534","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T10:42:22Z","timestamp":1769078542000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.advancedotology.org\/index.php\/pub\/article\/view\/1537"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,1]]},"references-count":0,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,7,16]]}},"URL":"https:\/\/doi.org\/10.5152\/iao.2021.9232","relation":{},"ISSN":["2148-3817"],"issn-type":[{"value":"2148-3817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,1]]}}}