Comparative study of microscope assisted tympanoplasty and endoscope assisted tympanoplasty

Aim: Endomeatal endoscopic tympanoplasty (ET) is a relatively new technique. We wanted to study the feasibility of performing this technique, its outcome using tragal perichondrium (TP) and its cosmetic benefits over the conventional microscopic tympanoplasty (MT) using temporalis fascia (TF). Patients and Methods: Study consisted of 81 patients in total between the age group 7 years to 70 years who fulfilled the inclusion criteria. Of these patients, 41 underwent MT using TP, while the remaining 40 underwent ET using TP as graft material. Results: For the graft uptake and hearing gain, ET and MT had similar outcomes, but time taken for surgery for ET was significantly less than the time taken for MT. In addition to this, satisfaction of clarity of view, depth perception, round window reflex, and ossicular chain visualization were all comparable in both groups but the visualization of the entire tympanic membrane was better in ET group. Cosmetic satisfaction of ET were significantly better than the MT group. Conclusion: Endoscope has a better visualization of the entire tympanic membrane without the need to manipulate the patients head. ET was an equally effective technique and TP was an efficient graft material. Conventional MT required a long post auricular incision, dissection and closure which lead to change in normal orientation of the pinna leading to poor cosmetic satisfaction. The dissection and closure also extended the duration of surgery which was not required in endoscopic technique which lead to significant reduction of duration of surgery and better cosmesis.