Surgical Outcomes of Endoscopic Transtympanic Myringoplasty Versus Over-Underlay Tympanoplasty Type I Versus Overlay Tympanoplasty Type I for Tympanic Membrane Perforations.

Objective: To compare the surgical outcomes of endoscopic transtympanic myringoplasty versus endoscopic over-underlay tympanoplasty versus endoscopic overlay tympanoplasty.

Study design: Retrospective chart review.

Setting: Tertiary referral university hospital.

Patients: Adult subjects with first diagnosed dry tympanic membrane perforation for at least 3 months who underwent endoscopic tympanoplasty between September 2021 and January 2024.

Intervention: Endoscopic transtympanic myringoplasty (ETM), endoscopic over-underlay tympanoplasty (EDT), and endoscopic overlay tympanoplasty (EVT).

Main outcome measures: The primary outcome was graft success rate at 6 months after surgery. Secondary outcomes were audiologic data including preoperative and postoperative pure-tone air average, pure-tone bone average, and air-bone gap (ABG).

Results: A total of 82 endoscopic tympanoplasty cases were included: 25 in ETM, 30 in EDT, and 27 in EVT. The overall graft success rate was 93.9%. The graft success rates were not different between the three groups: 92.0% in the ETM group versus 93.3% in the EDT group versus 96.3% in the EVT group (p = 0.860). Pure-tone air average improved significantly after surgery in all groups, and hearing gains for ETM, EDT and EVT were 7.9 ± 6.5, 11.3 ± 7.3, and 10.8 ± 6.2 dB, respectively, which were comparable (p = 0.141).

Conclusions: Favorable graft success rates and audiologic outcomes were obtained in all groups. The ETM method is more suitable for medium-sized tympanic membrane (TM) perforations because it is easier to perform and minimally invasive. For large TM perforations, we suggest the EDT or the EVT method, depending on perforation size, location, and preoperative ABG.