Endoscopic Versus Microscopic Tympanoplasty: A Single-Blinded Randomized Comparative Trial

To provide prospective evidence comparing differences in audiometric and patient-reported outcomes following endoscopic and microscopic tympanoplasty techniques.

Single-blinded prospective randomized comparative trial.

Tertiary care center between 2022 and 2023.

English- and Spanish-speaking adults undergoing transcanal tympanoplasty for dry tympanic membrane perforation (without cholesteatoma or chronic ear disease).

Endoscopic or microscopic tympanoplasty.

The primary outcome was air-bone gap change at 3 months. Secondary measures included speech recognition thresholds (SRT), word recognition scores (WRS), and patient-reported outcome measures (PROMs), including visual analog scale (VAS) of pain, Return to Work Self-Efficacy (RTWSE-19), and Glasgow Benefit Inventory (GBI).

Thirty-eight adults (mean age, 39.9 yr; range, 21-74 yr) were enrolled. Fifteen received microscopy, and 16 received endoscopy. Seven were excluded from the analysis: three required a post-auricular incision, and four were lost to follow-up without postoperative audiograms. Only PROMs collected within 3 weeks postoperatively were analyzed due to high participant dropout rates beyond 3 weeks. There were no differences in any audiometric or patient-reported outcomes between treatment groups ( p > 0.05).

Our findings suggest that transcanal endoscopic and microscopic approaches to tympanoplasty do not differ in postoperative audiometric outcomes or PROMs.