Preservation Versus Resection of the Anterior Malleolar Handle During Endoscopic Tympanoplasty: A Retrospective Comparative Study

ObjectivesTo compare audiological and anatomical outcomes between preservation and resection of the anterior malleolar handle during endoscopic tympanoplasty.MethodsA retrospective comparative study was performed in 45 patients with chronic suppurative otitis media who underwent endoscopic tympanic membrane repair between January 2022 and April 2025. Patients were divided according to intraoperative management of the anterior malleolar handle into a preservation group (Group A, n = 23) and a resection group (Group B, n = 22). The decision to preserve or resect the anterior malleolar handle was made intraoperatively based on surgical exposure, epithelial adhesion at the malleolar tip, and graft stability. Audiological outcomes, tympanic membrane healing, and postoperative complications were evaluated.ResultsSignificant postoperative improvement in air-bone gap (ABG) was observed in both groups. Mean ABG improved from 18.87 ± 7.95 dB HL to 13.70 ± 4.69 dB HL in Group A (P = .002) and from 20.10 ± 6.59 dB HL to 15.75 ± 5.67 dB HL in Group B (P = .009). No significant differences were found between groups in preoperative ABG, postoperative ABG, or ABG closure. Functional hearing success (postoperative ABG ≤20 dB HL) was achieved in 91.3% of patients in Group A and 77.3% in Group B (P = .243). Tympanic membrane closure was achieved in 91% of patients in both groups. No postoperative facial paralysis or vertigo occurred.ConclusionBoth preservation and resection of the anterior malleolar handle were associated with significant hearing improvement and high graft healing rates following endoscopic tympanoplasty. Within the limitations of this retrospective study, limited resection of the anterior malleolar handle may be a useful option when additional surgical exposure or graft stability is required.