Introduction
An endoscope is a relatively new tool in the field of otology which is
gradually gaining its acceptance in the community. After the development
of Hopkins rod endoscope by Harrold Hopkins1 in 1966,
it was only in 1992, when El Guindy 2 from Egypt
published the first paper on total endoscopic ear surgery i.e.
myringoplasty using a fat graft. Between 1966 to 1992, most of the
studies published were based on secondary endoscopic ear surgery i.e.
endoscopic assisted microscopic ear surgery.1,3However, the microscope is still considered as a gold standard tool in
otology.3 Tympanoplasty is considered one of the most
common procedures done by otologists to repair tympanic membrane (TM)
and to restore hearing.4 Graft material commonly used
is temporalis fascia, but it has recently been replaced by cartilage,
especially for anterior and subtotal perforation because of stability
and long-term uptake results.5 Different techniques
are described in the literature for doing tympanoplasty which includes
overlay, underlay, and over-underlay techniques with each having pros
and cons.6,7,8 The most commonly used technique
worldwide seems to be an underlay technique because it is easier to
perform and less time-consuming.6,2
Chronic otitis media (COM) with large perforation, subtotal perforation,
atelectasis, adhesive otitis media, cholesteatoma, tympanosclerotic
cases, revision cases are considered as high-risk cases with poor uptake
results.9 Among them anterior perforation is also
considered as the poor prognostic factor for the graft uptake because of
its difficult access, reduced vascularity, and graft
instability.10, 11
Microscopy has been the most commonly used tool for ear surgery;
however, due to its straight-line vision, it limits the exposure of
anterior quadrant or marginal perforations.12 To
overcome this, more invasive procedures that enlarge the surgical field
are needed, such as canaloplasty or a postaural
approach.13 Because of these limitations, the use of
an endoscope is rapidly increasing in the past two decades. The main
advantage of endoscopes in tympanoplasty is its wider field of view,
magnification, high definition image, and superior visualization,
including anterior margins avoiding postaural approach and
canaloplasty.13,14 In this study, we evaluated the
difference between the graft uptake rate, surgical duration, and hearing
evaluation between endoscopic and microscopic type I tympanoplasty in
COM with anterior perforation.