Outcomes After Exoscopic Versus Microscopic Type 1 Tympanoplasty

Abstract

Objective To analyze the outcomes of exoscopic versus microscopic type 1 tympanoplasty. Study Design Retrospective chart review. Setting Tertiary care otology-neurotology practice. Patients Adult subjects with a diagnosis of tympanic membrane perforation from 2018 to 2022. Intervention Exoscopic or microscopic tympanoplasty with cartilage + perichondrium or perichondrium/fascia graft. Main Outcome Measures Primary outcomes were graft success rate (1 wk, 3 wk, 3 mo, and 6 mo postoperatively) and operative time. Secondary outcomes included audiometric outcomes of postoperative air-bone gap (ABG), change in ABG, pure tone average (PTA), speech reception threshold (SRT), and word recognition score (WRS) at 6-month follow-up and complication rates of cerebrospinal fluid leak, facial nerve injury, persistent tinnitus, and persistent vertigo. Results Seventy-one patients underwent type 1 tympanoplasty by a single surgeon. Thirty-six patients underwent exoscopic tympanoplasty, and 35 patients underwent microscopic tympanoplasty. Cartilage and perichondrium were utilized in 27 subjects (75.0%) in the exoscopic group and in 25 subjects (71.4%) in the microscopic group (p = 0.7, Cramer’s V = 0.04). Graft success rate was as follows (exoscope versus microscope): 100% (36/36) versus 100% (35/35) at 1 week (p = 1.0, Cramer’s V = 0.0), 97.2% (35/36) versus 100% (35/35) at 3 weeks (p = 1.0, Cramer’s V = 0.1), 97.2% (35/36) versus 94.3% (33/35) at 3 months (p = 1.0, Cramer’s V = 0.07), and 91.7% (33/36) versus 91.4% (32/35) at 6 months (p = 0.7, Cramer’s V = 0.0). Operative time was 57.7 minutes for the exoscopic group and 65.4 minutes for the microscopic group (p = 0.08, 95% CI [−16.4, 0.9], Cohen’s d = 0.4). There were no serious complications. All preoperative and postoperative audiometric outcomes were comparable. Conclusions The outcomes after exoscopic versus microscopic type 1 tympanoplasty are comparable.