Endoscopic tympanoplasty using small intestinal submucosa xenografts for large tympanic membrane perforations: a one-year retrospective cohort study with clinical follow-up

Abstract Background To evaluate the anatomical and audiological outcomes of endoscopic tympanoplasty using porcine small intestinal submucosal (SIS) xenografts for repairing large tympanic membrane (TM) perforations. Methods This retrospective study included 102 patients with tympanic membrane perforations involving more than 50% of the pars tensa who underwent transcanal endoscopic tympanoplasty. Among them, 52 received small intestinal submucosa (SIS) grafts and 50 received perichondrial grafts. All patients were followed for at least 12 months. Anatomical outcomes were evaluated using otoscopic examination, and audiological outcomes were assessed using pure-tone audiometry. Multiple linear regression was performed to determine the association between clinical variables (age, sex, and comorbidities) and postoperative air–bone gap (ABG) gain. Results The graft uptake rates were 88.5% for SIS and 86% for perichondrium. Significant postoperative improvements in ABG were observed across all tested frequencies, with no significant differences between the two graft types. In the SIS group, patients younger than 65 years demonstrated significantly greater ABG gain compared with those aged 65 years or older (11.8 ± 8.3 dB vs. 5.8 ± 10.0 dB; p = 0.005). Sex and comorbidities were not associated with audiological outcomes. No major postoperative complications were observed. Conclusions Endoscopic tympanoplasty with SIS xenografts is a reliable and effective option for the repair of large tympanic membrane perforations, demonstrating high graft uptake rates and satisfactory postoperative hearing improvement.