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tympanic membrane (TM) and to restore hearing.4 Graft material commonly used is temporalis fascia, but it has recently been replaced by cartilage, especially for anterior and subtotal perforation because of stability and long-term uptake results.5 Different techniques are described in the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.