Endoscopic versus microscopic tympanoplasty: A prospective randomized comparison of outcomes

Background/Aim: There is a limited number of systematic comparisons and comprehensive studies on auditory outcomes, graft success, and complication rates between traditional microscopic and newer endoscopic tympanoplasty techniques. Hence, we aim to compare these two techniques, namely endoscopic and microscopic type-1 tympanoplasty, in terms of anatomical and functional outcomes. Methods: This prospective randomized clinical trial included 40 adult patients, divided equally between those undergoing microscopic and endoscopic tympanoplasty. To eliminate selection bias, the sequence of operations alternated between the two methods based on the patients’ arrival order. Each patient’s pre-operative conditions and outcomes 6 months post-surgery were evaluated using pure tone audiometry tests and assessments of the tympanic membrane. For both groups, the tragal perichondrial cartilage composite graft served as graft material. Functional assessments evaluated the air conduction threshold and bone conduction threshold averages at frequencies of 500, 1000, 2000, and 4000 Hz, both pre-operatively and 3 months after the operation. Air conduction gain was determined by comparing the air bone gap at application with that 6 months post-surgery. The size of the tympanic membrane perforation was calculated as a percentage of the total area using ImageJ, and the correlation with functional gain was assessed. The condition of the tympanic membrane and graft position were documented 6 months post-surgery using IBM SPSS Statistics Version 26. Results: We compared mean (standard deviation [SD]) pre-operative air conduction threshold values between the endoscopic group (30.11 [5.19]) and the microscopic group (28.45 [5.19]) and found no significant difference (P=0.404). Similarly, we found no significant difference (P=0.169) in pre-operative air bone gap values between the endoscopic group (24.58 [5.35]) and the microscopic group (27.17 [6.34]). Post-operative air conduction threshold values in the endoscopic group (17.09 [11.28]) and the microscopic group (13.55 [7.99]) also showed no significant difference (P=0.258). The same was true for post-operative air bone gap values in the endoscopic group (13.97 [10.91]) and the microscopic group (9.63 [7.83]) (P=0.156). The average air conduction gain, an indicator we used to evaluate the functional success of the surgery, was similarly non-significant between the endoscopic group (13.08 [7.47]) and the microscopic group (14.90 [5.04]) (P=0.395). Conclusion: Our study findings suggest that an endoscope is at least as effective as the microscopic method in type-1 tympanoplasty. Moreover, with advantages like reduced surgical time and broad-angle viewing capabilities, the endoscopic method is poised to gain popularity.