A Comparative Study between Endoscopic Tympanoplasty and Microscopic Tympanoplasty

Background: Chronic tympanic membrane perforation secondary to chronic otitis media is a common otological condition requiring surgical repair to achieve a dry ear and improve hearing. Microscopic tympanoplasty has traditionally been considered the standard technique; however, endoscopic tympanoplasty has emerged as a minimally invasive alternative with potential advantages in visualization, cosmesis, and recovery. The aim is to compare the anatomical, functional, and patient-related outcomes of endoscopic tympanoplasty and microscopic tympanoplasty. Material and Methods: A prospective comparative study was conducted in the Department of Otorhinolaryngology at Santosh Medical College and Hospitals over 18 months. A total of 50 patients with chronic tympanic membrane perforation were included and divided into two groups: endoscopic tympanoplasty (n=25) and microscopic tympanoplasty (n=25). Preoperative assessment included otoscopy, tuning fork tests, and pure tone audiometry. Postoperative outcomes including graft uptake, hearing improvement, complications, and patient satisfaction were evaluated and compared. Results: Successful graft uptake was achieved in 96% of patients in the endoscopic group and 92% in the microscopic group (p=1.000). Postoperative air–bone gap was lower in the endoscopic group (11.54 ± 9.45 dB vs 16.88 ± 10.92 dB). Mean hearing improvement was greater with endoscopic tympanoplasty (15.86 ± 3.87 dB vs 13.66 ± 5.06 dB), although statistically insignificant. Postoperative complications were fewer in the endoscopic group. Cosmetic satisfaction was higher among endoscopic patients (88% vs 60%), and fewer hospital visits were required (84% vs 52%, p=0.032). Conclusion: Endoscopic tympanoplasty provides anatomical and functional outcomes comparable to microscopic tympanoplasty while offering additional benefits of reduced postoperative morbidity, better cosmetic satisfaction, and faster recovery. It represents an effective minimally invasive alternative for tympanic membrane reconstruction.

Keywords: Endoscopic tympanoplasty; Microscopic tympanoplasty; Chronic otitis media; Tympanic membrane perforation; Graft uptake; Hearing outcome; Air–bone gap.