A Comparative Study to Evaluate the Efficacy of Microscope Assisted Versus Endoscope Assisted Tympanoplasty

ABSTRACT

Tympanoplasty is a common surgery for chronic otitis media. Few studies have looked at the outcomes of microscope assisted (MT) and endoscope assisted (ET) tympanoplasty. Aim: The study aims to analyze the results of endoscope and microscope assisted approaches for tympanoplasty in patients with chronic otitis media. Outcomes were intra-operative and post operative complications as well as functional outcomes (i.e. improvement in hearing as assessed by pure tone audiometry)/. Methods: This study was conducted at a tertiary care hospital. It included 100 subjects – 50 each in Microscope assisted tympanoplasty (MT) and endoscope assisted tympanoplasty (ET) assisted group. Study participants included those with chronic otitis media with central perforation and dry ear for 4 weeks. All the subjects underwent Type 1 tympanoplasty using either endoscopic or microscopic technique. The subjects were assigned to the above two groups alternatively. The key outcomes assessed were time taken for surgery (incision to closure), comfort level of the patient (by measuring pain score), proportion with graft rejection in both the groups and improvement in hearing. Results: We found that endoscope assisted surgery (ET) led to improvement in bone and air conduction and decreased air bone gap, compared to microscope assisted tympanoplasty (MT). There was a 15.5 dB improvement in MT group while the corresponding improvement in ET group was 16.8 dB (P=0.04). The mean improvements in post-operative air conduction were 29.8 dB and 26.1 dB respectively in ET and MT groups (P=0.02). The post-operative air bone conduction gap was 9.9 dB and 7.8 dB respectively in MT and ET groups (P=0.03). We also observed significantly reduced intra-operative pain scores and post-operative pain scores in those who were operated using endoscopy. Conclusion: The endoscope assisted tympanoplasty offers better outcome than microscope assisted approach and is a better choice for surgery