Optimal Grafting Methods in Endoscopic Type 1 Tympanoplasty: A Comprehensive Guide

The intricacies of Endoscopic Type 1 tympanoplasty necessitate a bespoke surgical methodology, particularly in graft selection, to efficaciously address individual variances in tympanic membrane (TM) perforations. This manuscript delineates our investigative insights into the nuanced process of graft technique determination before endoscopic tympanoplasty, underscoring the pivotal role of personalized surgical strategies in optimizing patient outcomes. This study encompassed a cohort of thirty patients stratified into three groups based on a constellation of criteria: external ear canal dimensions, dermal characteristics, TM perforation location, and magnitude, alongside assessments of comorbidities and historical chronic otitis instances. These parameters were instrumental in guiding the selection of grafting modalities, including butterfly, fat, underlay tragal perichondrium, and tragal cartilage-perichondrium island techniques. Patient satisfaction was quantitatively evaluated using the Visual Analogue Scale (VAS), and comparative analyses of preoperative versus postoperative audiometric data were performed at a six-month interval post-surgery. The application of patient-specific grafting strategies demonstrated efficacy, as evidenced by the lack of necessity for surgical revision across all cohorts. Audiometric assessments revealed no significant discrepancies in auditory enhancement across various frequencies both within and across the groups, pre- and postoperatively. The efficacy of Endoscopic Type 1 tympanoplasty is substantially contingent upon the customization of grafting techniques. This investigation corroborates the hypothesis that a comprehensive preoperative evaluation, incorporating a multitude of patient-specific factors, is imperative for identifying the optimal grafting approach. Such individualized methodologies significantly bolster surgical success rates and enhance patient satisfaction in managing chronic otitis media sequelae.