A Comparative Study of Functional and Anatomical Outcomes in Endoscopic versus Microscopic Type I Tympanoplasty for Chronic Otitis Media Mucosal Disease

Introduction: Chronic otitis media mucosal disease with tympanic membrane perforation is commonly treated using type I tympanoplasty. Traditionally performed using a microscope, the advent of endoscopic ear surgery has introduced a minimally invasive alternative. This study aims to compare the functional hearing outcomes and anatomical graft uptake following endoscopic versus microscopic type I tympanoplasty. Materials and Methods: A prospective observational study was conducted at MES Medical College, Perinthalmanna, involving 48 patients aged 15–45 years with inactive mucosal chronic otitis media. Patients were randomly divided into two groups: 24 underwent endoscopic tympanoplasty and 24 underwent microscopic tympanoplasty. Temporalis fascia graft was used in all patients. Pre- and postoperative hearing assessments were done using pure tone audiometry, and graft uptake was evaluated at 3 months. Statistical analysis was performed using SPSS with chi-square and t-tests applied; a p-value < 0.05 was considered significant. Results: The mean preoperative air-bone gap (ABG) was 29.71 ± 4.63 dB, which improved significantly postoperatively to 13.25 ± 1.99 dB (p < 0.001). The endoscopic and microscopic groups showed similar improvements in ABG (p = 0.354). Graft uptake was successful in 95.8% of endoscopic cases and 91.7% of microscopic cases (p = 0.551). Two cases of suture site infection were reported, both in the microscopic group. No major complications were observed. Conclusion: Both endoscopic and microscopic tympanoplasty are effective in the management of chronic otitis media mucosal disease. Endoscopic tympanoplasty offers comparable hearing outcomes and graft success rates, with added advantages of minimal invasiveness and superior cosmesis.