Outcomes of endoscopic tympanoplasty in chronic suppurative otitis media: a prospective study from a tertiary care hospital

Background: Chronic suppurative otitis media (CSOM) remains a significant public health issue in developing countries like India, contributing substantially to preventable hearing loss. Although microscopic tympanoplasty is widely practiced, endoscopic tympanoplasty (ET) with its minimally invasive transcanal approach, offers enhanced surgical visualization, reduced morbidity, comparable graft success rates and is particularly well-suited for high-volume tertiary centers where surgical efficiency and cost-effectiveness are critical. This study evaluates the outcomes of ET in terms of graft success, hearing improvement, and surgical efficacy. Methods: A prospective study was conducted from August 2022 to August 2024, involving 70 patients diagnosed with tubotympanic type of CSOM. All patients underwent ET using a superiorly based tympanomeatal flap with an underlay grafting technique. Preoperative and postoperative audiological assessments were performed using pure tone audiometry at 1-month and 3-month intervals. The primary outcome measures included graft uptake rate, air-bone gap (ABG) closure, surgical duration, and postoperative complications. Results: The study population had a male-to-female ratio of 1:2, with the majority (52%) aged between 10-30 years. The overall graft uptake success rate was 91.43% (64/70), with a statistically significant improvement in hearing outcomes. The mean preoperative ABG of 29.44 dB (95% CI: 28.10-30.78) improved to 13.60 dB at 3 months postoperatively (95% CI: 12.56-14.64 dB) at three months postoperatively (p<0.01). Surgical complications were minimal, and no major adverse events were noted. Conclusions: ET demonstrates high success rates, substantial hearing improvement, and minimal complications, confirming its effectiveness in managing tubotympanic CSOM. The procedure offered the advantages of enhanced visualization provided by endoscopy facilitates precise graft placement and optimal surgical outcomes, shorter surgical time, faster postoperative recovery, and minimal complications. Its minimally invasive nature and favorable outcomes make it a reliable alternative to the microscopic approach, warranting its integration into routine clinical practice and otologic training programs for improved patient care.