Comparative outcomes between endoscopic and microscopic approaches in pediatric type-1 tympanoplasty

Abstract

Objectives

Type-1 tympanoplasty is a surgical procedure employed to repair the tympanic membrane, when ossicular reconstruction is not required. Historically, this was performed via a microscopic approach utilizing either a transcanal, endaural, or postauricular incision. Recently, there has been a growing shift toward the use of transcanal endoscopic ear surgery (TEES), eliminating the need for an endaural or postauricular incision. This study seeks to evaluate and compare outcomes between TEES and non-TEES type-1 tympanoplasty in a pediatric population, specifically tympanic membrane closure rates and post-operative audiometric results.

Methods

A retrospective review of all pediatric patients who underwent type-1 tympanoplasty at a tertiary care hospital between 2016 and 2020 was performed. Differences in tympanic membrane perforation closure rates and audiometric results between patients who underwent TEES vs. non-TEES were tested using Fisher's Exact and Mann-Whitney U tests. Logistic regression with stepwise selection and linear regression were used to compare factors among groups.

Results

118 patients underwent type-1 tympanoplasty (85 TEES, 33 non-TEES). Rate of closure was higher for patients who underwent TEES (91.76 %, 78/85) compared to non-TEES (69.7 %, 23/33) (Fisher's exact p = 0.006). Patients who underwent TEES had a greater reduction in post-operative PTA (median = −9 dB, IQR = −15 to −3 dB, n = 74) than those who underwent non-TEES (median = −5 dB, IQR = −11 to 3 dB, n = 31) (Mann Whitney p = 0.015).

Conclusion

In the study population, closure rates and audiometric outcomes were superior in patients who underwent type-1 tympanoplasty using TEES compared to non-TEES.

Level of evidence

III.