Impact of Perforation Attributes, Surgical Experience, and Graft Type in Two-Handed Endoscopic Type 1 Tympanoplasty: a Multi-Center Study

Background: Two-handed endoscopic Type 1 tympanoplasty (T1TP) is a minimally invasive surgical technique addressing limitations in precision and dexterity associated with single-handed endoscopic approaches. Despite its potential, comprehensive multicentre evaluations of its outcomes remain limited. Objective: To assess the anatomical and functional outcomes of two-handed endoscopic T1TP, considering factors like surgeon experience, perforation characteristics, and graft material selection. Methods: This retrospective multicentre study analyzed 550 patients (aged 6–70 years) with mucosal chronic otitis media across five tertiary care centres in India. Data on demographics, perforation size/location, graft material, and pre/postoperative audiometric parameters were collected. Outcomes included graft uptake rates, air-bone gap (ABG) closure, and hearing improvement at 6 and 12 months. Results: Overall graft uptake success rate of 94%, with small anterior perforations demonstrating superior outcomes. Younger patients (< 30 years) showed the greatest ABG reduction (20–25 dB), while improvements were lower in older age groups (> 50 years).Surgeon Experience: Closure rates increased from 78% (0–50 cases) to 97% (> 200 cases); operative duration decreased from 95 ± 8 to 72 ± 6 min with experience. Temporalis fascia and cartilage both yielded significant audiometric improvements, with cartilage providing better structural support for larger perforations. Conclusion: Two-handed endoscopic T1TP is a transformative approach offering high anatomical and functional success rates, particularly for challenging perforations. Surgeon training, graft optimization, and tailored patient strategies are critical for maximizing outcomes.