Endoscopic Overlay Myringoplasty: A Feasible Endoscopic Variant With Potential for Improved Graft Stability

Overlay myringoplasty is a well-established technique for repairing challenging tympanic membrane perforations, particularly anterior and subtotal defects. We report our experience with an endoscopic variant using cartilage grafts, which appears feasible and may offer favorable graft stability. This retrospective case series included five patients who underwent endoscopic cartilage overlay myringoplasty between February 2024 and February 2025. The grafts were placed laterally to the fibrous layer and medially to the tympanic membrane skin and canal skin flap. Anatomical and functional outcomes were evaluated postoperatively. Successful anatomical closure was achieved in all cases, with measurable hearing improvement. No complications such as graft lateralization, blunting, infection, or epithelial cyst formation were observed. The endoscopic approach facilitated visualization of the anterior margin and allowed precise graft placement. Endoscopic overlay myringoplasty represents a reliable and feasible technical variant. By combining the advantages of the overlay principle with endoscopic exposure, this approach may provide favorable graft stability and satisfactory functional outcomes, especially in challenging anterior or subtotal perforations.