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Retrospective evaluation of the surgical result of tympanoplasty for inactive chronic otitis media and comparison of endoscopic versus microscopic tympanoplasty

Context: The evaluation of techniques of middle ear surgery is fraught with difficulty due to varieties of surgical technique and several confounding factors. Although endoscopic middle ear surgery has been described in English literature for decades, there are limited data comparing surgical result with microscopic tympanoplasty as highlighted by recent systematic reviews of literature. Aims: (1) To evaluate the surgical result of tympanoplasty only for patients with inactive chronic otitis media of mucosal type in our institution. (2) To compare the surgical result obtained by endoscopic tympanoplasty with postaural approach microscopic tympanoplasty. Settings and Design: This retrospective study carried out in M.S. Ramaiah Hospitals, Bengaluru, Karnataka, India. Materials and Methods: Retrospective study of the inpatient and outpatient records of patients with inactive chronic otitis media operated by a single surgeon from May 2010 to September 2015. Statistical Analysis Used: Chi-square test was used to compare the qualitative results and Student's t-test was used to compare quantitative results with a level of significance of P= 0.05. Results: A total of 44 ears in 42 patients were analyzed. There were 16 ears operated by transcanal endoscopic method, and 28 ears operated by postaural microscopic post method. The operative time was significantly less (difference of means 16.2 min) for endoscopic versus microscopic approach. Primary transcanal endoscopic superior flap tympanoplasty had statistically comparable surgical success with postaural microscopic anterior vascular strip tympanoplasty (92.9% vs. 88.5%).Discussion: In this retrospective study, by appropriate case selection, we have attempted to reduce the factors which may confound the result of tympanoplasty, such as the use of ancillary procedures such as cortical mastoidectomy. The transcanal endoscopic and postaural microscopic approach as practiced by us had similar outcomes. We found reduced operative time for transcanal endoscopic approach to tympanoplasty. Conclusions: Tympanoplasty alone for inactive chronic otitis media of mucosal type is an effective primary treatment option. Transcanal endoscopic approach is surgically as effective as postaural microscopic approach and may be associated with reduced operative time. Additional evaluation is required for revision cases and for comparing the audiometric result.