Endoscopic Versus Microscopic Pediatric Tympanoplasty: Is There a Difference Between Closure Rates and Hearing Outcomes?

Objective: To compare closure rates and hearing outcomes of microscopic and endoscopic tympanoplasty in pediatric patients.

Study Design: Retrospective chart review.

Setting: Tertiary university medical center.

Patients: Pediatric patients who underwent tympanoplasty surgery by a fellowship-trained neurotologist between 2010 and 2019 with a minimum of 2 months of follow-up, a tympanic membrane perforation, and no preoperative cholesteatoma.

Interventions: Transcanal endoscopic tympanoplasty or microscopic tympanoplasty (MT) surgery.

Main Outcome Measures: The primary outcome is postoperative closure of the tympanic membrane perforation, assessed using otomicroscopy at the last follow-up appointment. Secondary outcomes include operative time and changes in the air-bone gap (ABG) and pure-tone average (PTA).

Results: Two hundred eleven tympanoplasty operations were analyzed: 121 in the transcanal endoscopic ear surgery (TEES) group and 90 in the MT group. Tympanic membrane closure rates were no different between the two groups (TEES, 82.6%; MT, 88.9%; p = 0.24), and no significant association was found on multivariable analysis (TEES: odds ratio, 0.8; p = 0.61). Both groups showed improvements in the 4-month PTA and ABG and the 12-month PTA, but the 12-month ABG only improved in the TEES group ( p < 0.01). The TEES group had a shorter average operative time (109.8 versus 123.5 min; p = 0.03) and less need for a postauricular incision (2.5% versus 93.3%; p < 0.01).

Conclusion: In pediatric tympanoplasty, TEES gives similar membrane closure and hearing outcomes as the microscopic technique, with less operative time and less need for a postauricular incision.