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Endoscopic vs. microscopic tympanoplasty in children: a retrospective case-control study
Raffael Fink1, Sven Beckmann1, Sean C Sheppard1,2
1Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Frontiers in Surgery
|October 2, 2025
Summary
Endoscopic tympanoplasty in children shows comparable hearing results and graft success to microscopic methods. This approach offers shorter surgery times and fewer complications, especially for cholesteatoma removal.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Minimally Invasive Procedures
Background:
- Tympanoplasty (TPL) is a surgical procedure to repair the eardrum and ossicles.
- Both endoscopic and microscopic techniques are used for TPL, with varying outcomes.
- Pediatric patients present unique challenges for middle ear surgery.
Purpose of the Study:
- To compare the outcomes of endoscopic versus microscopic tympanoplasty (types I-III) in pediatric patients.
- To evaluate audiological results, graft uptake, residual disease, operative time, and complications.
Main Methods:
- Retrospective case-control study of 70 TPL procedures in 58 pediatric patients.
- Data collected from June 2017 to December 2023 at Inselspital, Bern University Hospital, Switzerland.
- Comparison of hearing function (air-bone gap), graft intake, residual disease, operative time, and complications between endoscopic and microscopic groups.
Main Results:
- Similar mean postoperative air-bone gap (16.83 dB endoscopic vs. 19.37 dB microscopic) and graft intake rates (91% endoscopic vs. 80% microscopic).
- Significantly lower incidence of residual cholesteatoma in the endoscopic group (0%) compared to the microscopic group (42%; p=0.03).
- Shorter mean operative time for endoscopic TPL (87 min vs. 113 min; p<0.01) and fewer postoperative complications.
Conclusions:
- Endoscopic tympanoplasty in pediatric patients yields comparable audiological outcomes and graft success rates to the microscopic approach.
- The endoscopic technique offers significant advantages, including reduced operative times and lower complication rates.
- Endoscopic TPL is highly effective for cholesteatoma resection, providing excellent functional and structural results in children.
