Quality-of-Life and Cosmetic Outcomes With Endoscopic Versus Microscopic Endaural and Postauricular Type I Tympanoplasty

Introduction: Endoscopic and microscopic tympanoplasty yield comparable anatomic and audiologic results, but the influence of incision choice on patient-reported cosmetic outcomes is less clear. Material and Methods: In this retrospective, non-randomized study, records of 197 patients who underwent type I tympanoplasty between January 2022 and January 2025 were reviewed; 91 patients completed at least 12 months of follow-up and the patient-reported outcome questionnaires (endoscopic n=30, endaural n=31, postauricular n=30). Outcomes included graft success, Δair–bone gap (ABG) closure, Glasgow Benefit Inventory (GBI), and EAR-Q domains. Results: Graft success was similar across groups (93.3–93.5%; p=0.999) and ABG closure did not differ (7.23±3.90, 7.26±3.44, 6.30±3.44 dB; p=0.502). GBI and EAR-Q Psychological/Social scores were comparable (all p>0.05). In contrast, cosmetic EAR-Q scores differed significantly, with less favorable scores in the postauricular group and highest satisfaction in the endoscopic group (all p≤0.01). Conclusion: While functional outcomes were similar, endoscopic tympanoplasty—and, among microscopic techniques, the endaural approach—may provide favorable patient-reported cosmetic outcomes, informing approach selection in suitable patients.