Endoscopic vs Microscopic Overlay Tympanoplasty for Correcting Large Tympanic Membrane Perforations: A Randomized Clinical Trial

Objective Although overlay grafting for complicated tympanic perforations offers a high success rate, potential complications may outweigh its advantages. This study aimed to assess endoscopic overlay tympanoplasty (EOT), compared with microscopic overlay tympanoplasty (MOT), to optimize outcomes while minimizing complications associated with large tympanic perforations. Study Design Nonmasked, randomized. Setting Tertiary care university hospital. Subjects and Methods Altogether, 70 patients with large tympanic perforations were randomized to undergo overlay tympanoplasty between June 2014 and July 2016. Primary outcome was the visual analog scale (VAS) of pain. Secondary outcomes were anatomic closure, hearing results, middle ear findings, and postoperative complications. Results Overall, 34 EOT patients and 30 MOT patients completed the follow-up. VAS scores at 4, 24, and 48 hours in EOT and MOT groups were, respectively, 3 and 8, 1.7 and 6.0, and 0.6 and 4.1. Postoperative pain was less in the EOT group (P < .001), and canalplasty was not required (P = .003). Graft "take" rates for EOT and MOT were 97.1% and 93.3%, respectively (P = .60). Postoperative air-bone gap was lower with EOT (5.0 vs 10.3 dB) (P = .01). Various middle ear structures were more visible after EOT than after MOT (P < .001). Ear protrusion (P = .008) and postauricular numbness (P < .001) occurred after 50 MOTs. Conclusion EOT for repairing large tympanic perforations provides more favorable anatomical and audiometric outcomes. It also offers superior visibility of middle ear structures without lifting the annulus, with fewer complications and less invasiveness than MOT.