Predictors of Surgical Success and Hearing Outcomes in Endoscopic Cartilage Tympanoplasty: A Ten-Year Retrospective Study.

Abstract

Endoscopic tympanoplasty provides superior surgical capabilities compared with microscopic technique. We aimed to investigate the surgical and functional success rates of endoscopic cartilage tympanoplasty and identify the predictors of poor outcomes. We analyzed the data for all patients who underwent endoscopic cartilage tympanoplasty at Bahrain Defence Force Royal Medical Services, Military hospital between March 2014 and April 2024. Patient demographics, clinical characteristics were analyzed. Inclusion criteria included patients with chronic otitis media and dry, stable TM perforations. Exclusions were active otitis media, perforations caused by trauma or cholesteatoma, and cases requiring mastoidectomy. Surgical success was defined as TM graft closure six months postoperatively, and functional hearing success was determined by achieving postoperative ABG ≤ 20 dB. A total of 132 patients (72 males, 60 females; mean age: 34.77 ± 16.2 years) were included. The overall surgical success rate was 81.8%, with variations across age groups. Central perforations were the most common (51.5%) and had an 81% success rates. Audiological outcomes showed significant ABG closure, with a mean pre-operative ABG of 16.34 ± 9.4 dB reducing to 9.15 ± 10.0 dB post-operatively (p < 0.001), resulting in an average ABG reduction of 7.19 ± 9.8 dB. Social hearing (ABG ≤ 20 dB) was achieved in 91% of cases. Binary logistic regression identified smoking, granulation tissue, and age < 12 years as significant predictors of graft failure. Endoscopic technique demonstrates high surgical and functional success rates. Smoking, granulation tissue, and younger age negatively impacted outcomes emphasizing the importance of patient selection in optimizing results.