Endoscopic Versus Microscopic Tympanoplasty in Tympanic Membrane Perforation

Objective: This study was designed to compare the outcomes of tympanoplasty with endoscopic and microscopic approach in patients with tympanic membrane perforation. Study Design: Randomized controlled trial. Place and Duration of the Study:  ENT Department the Indus Hospital, Karachi, from 01-03-24 to 30-09-24. Methodology: This randomized controlled trail was condicted at the ENT Department the Indus Hospital, Karachi, from 01-03-24 to 30-09-24. A total of 86 patients with tympanic membrane perforation were into two groups (endoscopic tympanoplasty, Group A and microscopic tympanoplasty, group B) using a computer-generated random number sequence with a 1:1 allocation ratio. Forty-three patients in group A underwent endoscopic tympanoplasty and 43 patients in group B underwent microscopic tympanoplasty. Patients were followed up for 6 weeks and 3 months and outcomes were assessed. SPSS-19 was used for analysis of data. A comparison of the duration of the procedure between both groups was done by independent t-test. Graft uptake and hearing improvement between both groups were compared by using the chi-square/Fisher exact test. Results: There were 81.4% female and 18.6% male in group A and 76.74% female and 23.26% male in group B. Among patients, perforations were identified among 4 (9.3%) patients at 6 weeks follow-up in Group A and 5 (11.63%) in Group B. After a 3-month follow-up, hearing improvement was 81.4% in group A and 79.07% in group B, which was also not statistically significant between groups (p = 0.787). The mean duration of the procedure was significantly higher in group B as compared to group A [66.98±22.52 vs. 85.81±27.45; p=0.001]. Conclusion: This study provides preliminary evidence suggesting that endoscopic tympanoplasty is a feasible and effective surgical option for the management of tympanic membrane perforation. Although endoscopic tympanoplasty demonstrated comparable hearing improvement and post-operative perforation rates to conventional microscopic tympanoplasty, the differences between the two groups were not statistically significant. The endoscopic approach was associated with a shorter operative time; however, this difference also did not reach statistical significance. Larger, adequately powered randomized controlled trials are recommended to confirm these findings.