Iranian Journal of Otorhinolaryngology

Iranian Journal of Otorhinolaryngology

Endoscopic Transcanal Type 1 Tympanoplasty with Cartilage Perichondrium Graft; A Prospective Study

Document Type : Original

Authors
Parth Bipinkumar Makwana 1
Viral Prajapati 2
Vivek Makadiya 2
1 Department of ENT, Nootan Medical College, Visnagar, Gujarat, India.
2 Department of ENT, Dr. M. K.Shah Medical College, Ahmedabad, Gujarat, India.
10.22038/ijorl.2025.83887.3826
Abstract
Introduction:
Recently use of endoscopes for ear surgeries is being popular among the surgeons as it gives a wide view of the middle ear. Also, tympanoplasty by transcanal approach can be done as a day care procedure and so it reduces the cost of hospitalization. The study was aimed to evaluate the results of type 1 tympanoplasty done by endoscopic transcanal approach with cartilage perichondrium graft, in relation to successful graft take-up rate and improvement in hearing.
Materials and Methods:
Total 50 patients were included in the study and all of them underwent type 1 tympanoplasty by endoscopic transcanal approach. Tragal cartilage with its attached perichondrium on one side facing laterally was placed as graft lateral to handle of malleus with v shaped notch at 12 o clock by underlay technique in all the cases. Patients were called for regular follow-up, and they were observed for successful graft take-up and improvement in hearing at 3 months after procedure.
Results:
Out of 50 cases complete closure was achieved in 46 cases which makes a success rate of 92%. The average improvement in hearing of 15.3 dB was noted. 
Conclusion:
Endoscopic Transcanal approach with cartilage-perichondrium graft for tympanoplasty (type 1) is effective in terms of successful graft take-up rate and improvement in hearing, very cost effective, faster in terms of surgical time, and has less postoperative morbidity so gives better quality of life to the patient.
Keywords
Endoscopic tympanoplasty
Transcanal Tympanoplasty
Chronic Suppurative Otitis Media (CSOM)
Tympanic Membrane Perforation
Subjects
  1. Tympanoplasty: Tympanic Membrane Repair. In: Gulya, Minor LB, Poe DS, eds. Glasscock-Shambaugh’s Surgery of the ear. 6th ed. Connecticut: PMPH-USA; 2010: 28: 465.
  2. Farrior JB. Incisions in tympanoplasty: anatomic considerations and indications. The Laryngoscope. 1983; 93:75- 86.
  3. El-Guindy A. Endoscopic transcanal myringoplasty. J LaryngolOtol 1992; 106:493–5
  4. Raj A, Meher R. Endoscopic transcanal myringoplasty – A study. Indian J Otolaryngol Head Neck Surg 2001; 53:47–9
  5. Yadav SP, Aggarwal N, Julaha M, Goel A. Endoscope-assisted myringoplasty. Singapore Med J 2009;50: 510–12
  6. Ayache S. Cartilaginous myringoplasty: the endoscopic transcanal procedure. Eur Arch Otorhinolaryngol 2013;270(03):853–60
  7. Dündar R, Kulduk E, Soy FK, Aslan M, Hanci D, Muluk NB et al. C. Endoscopic versus microscopic approach to type 1 tympanoplasty in children. Int J Pediatr Otorhinolaryngol 2014;78: 1084–9
  8. Fadl FA. Outcomes of tympanoplasty-type 1. Saudi Med J. 2003;24(1):58-61.
  9. Levinson RM. Cartilage-perichondrial composite graft tympanoplasty in the treatment of posterior marginal and attic retraction pockets. Laryngoscope 1987; 97: 1069-74.
  10. Milewski C. Composite graft tympanoplasty in the treatment of ears with advanced middle ear pathology. Laryngoscope 1993; 103: 1352-6.
  11. Huang TY, Ho KY, Wang LF, Chien CY, Wang HM. A Comparative Study of Endoscopic and Microscopic Approach Type 1 Tympanoplasty for Simple Chronic Otitis Media. J Int Adv Otol 2016;12 (01):28–31
  12. Karhuketo TS, Ilomäki JH, Puhakka HJ. Tympanoscope-assisted myringoplasty. ORL J Otorhinolaryngol Relat Spec 2001;63(06): 353–357, discussion 358
  13. Mokbel KM, Moneir W, Elsisi H, et al. Endoscopic Transcanal Cartilage Myringoplasty for Repair of Subtotal Tympanic Membrane Perforation: A Method to Avoid Postauricular Incision. J Otolaryngol Rhinol. 2015; 1:2
  14. Singh R, Kundu S, Sarkar S, Ghosh B, Mukhopadhyay S. Comparative study of endoscopic temporalis fascia versus endoscopic cartilage tympanoplasty. Bengal J Otolaryngol Head Neck Surg 2013; 21:16–17
  15. Özgür A, Dursun E, Erdivanli ÖÇ, et al. Endoscopic cartilage tympanoplasty in chronic otitis media. J Laryngol Otol 2015; 129(11):1073–1077
  16. Vamanshankar, Hemanth & Mokshagundam, Ramakanth. (2020). Endoscopic Tragal Cartilage Graft for Tympanoplasty: A Case Series. 10. 31531/ edwiser.jjo.1000102.
  17. Shakya D, Kc A, Nepal A. A Comparative Study of Endoscopic versus Microscopic Cartilage Type I Tympanoplasty. Int Arch Otorhinolaryngol. 2020 Jan;24(1): e80-e85. doi: 10.1055/s-0039-1693139. Epub 2019 Nov 4. PMID: 31892962; PMCID: PMC6828568.
  18. Parab S.R., Khan M.M, Zaidi A. Endoscopic Cartilage Butterfly Tympanoplasty: A Two-Handed Technique with Endoscope Holder. Indian J Otolaryngol Head Neck Surg. 2022; 74 (Suppl 1), 100–105. https://doi.org/10.1007/s12070-020-01875-0
  19. Parelkar K, Thorawade V, Marfatia H, Shere D. Endoscopic cartilage tympanoplasty: full thickness and partial thickness tragal graft. Braz J Otorhinolaryngol. 2020 May-Jun;86(3):308-314. doi: 10.1016/j.bjorl.2018.12.006. Epub 2019 Feb 20. PMID: 30837190; PMCID: PMC9422511.
Iranian Journal of Otorhinolaryngology
Volume 37, Issue 5
September and October 2025
Pages 261-266