A comparison of endoscopic transtympanic myringoplasty and endoscopic type I tympanoplasty for repairing medium- to large-sized tympanic membrane perforation: a randomized clinical trial.

Introduction: Endoscopic type I tympanoplasty (ETT) is currently accepted as an effective, minimally traumatic procedure for repairing tympanic membrane perforation. However, ETT requires tympanomeatal flap elevation which chorda tympani nerve injury, bleeding and wound healing are the drawbacks of this technique. Thus endoscopic transtympanic myringoplasty (ETM) without elevation of the tympanomeatal flap is commonly used as an alternative technique. This study aimed to compare the efficacy of ETM versus ETT for repairing medium- to large-sized perforation of the tympanic membrane.

Methods: The study cohort comprised patients undergoing surgery for medium- to large-sized perforation of the tympanic membrane between February 2018 and February 2019. The patients were randomized into the ETM group and the ETT group. The main outcomes were the graft take rates and hearing results. Secondary outcomes were the operative time, visual analog scale (VAS) pain scores, and postoperative complications.

Results: Forty patients who completed 6 months of follow-up were included, comprising 21 patients in the ETM group and 19 in the ETT group. The overall graft take rates for the ETM and ETT groups were 95.2% and 89.5%, respectively (P = 0.59). The graft take rates for patients in the ETM group with large-sized tympanic membrane perforation was 88.9%. There was a significantly higher rate of good hearing result in the ETM group (95.2% versus 68.4%) (P = 0.04). The ETM group had significantly shorter operative times than the ETT group (P < 0.01).

Conclusion: Our results demonstrated that the surgical outcome of ETM is comparable to that of ETT. However, ETM is less invasive and has a shorter operative time than ETT, and is suitable for simple perforation repair, regardless of the perforation size.