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Background <p>Two-handed endoscopic Type 1 tympanoplasty (T1TP) is a minimally invasive surgical technique addressing limitations in precision and dexterity associated with single-handed endoscopic approaches. Despite its potential, comprehensive multicentre evaluations of its outcomes remain limited.</p> Objective <p>To assess the anatomical and functional outcomes of two-handed endoscopic T1TP, considering factors like surgeon experience, perforation characteristics, and graft material selection.</p> Methods <p>This retrospective multicentre study analyzed 550 patients (aged 6–70 years) with mucosal chronic otitis media across five tertiary care centres in India. Data on demographics, perforation size/location, graft material, and pre/postoperative audiometric parameters were collected. Outcomes included graft uptake rates, air-bone gap (ABG) closure, and hearing improvement at 6 and 12 months.</p> Results <p>Overall graft uptake success rate of 94%, with small anterior perforations demonstrating superior outcomes. Younger patients (&lt; 30 years) showed the greatest ABG reduction (20–25 dB), while improvements were lower in older age groups (&gt; 50 years).Surgeon Experience: Closure rates increased from 78% (0–50 cases) to 97% (&gt; 200 cases); operative duration decreased from 95 ± 8 to 72 ± 6&#xa0;min with experience. Temporalis fascia and cartilage both yielded significant audiometric improvements, with cartilage providing better structural support for larger perforations.</p> Conclusion <p>Two-handed endoscopic T1TP is a transformative approach offering high anatomical and functional success rates, particularly for challenging perforations. Surgeon training, graft optimization, and tailored patient strategies are critical for maximizing outcomes.</p>

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Impact of Perforation Attributes, Surgical Experience, and Graft Type in Two-Handed Endoscopic Type 1 Tympanoplasty: a Multi-Center Study

  • 期刊论文

  • 发表日期：

    2025年9月26日

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  • Amit Kumar Rana,
  • Deviprasad Dosemane,
  • Shivesh Kumar,
  • Mubarak M. Khan,
  • Sapna Ramkrishna Parab,
  • Rizwan Menon

摘要

Background

Two-handed endoscopic Type 1 tympanoplasty (T1TP) is a minimally invasive surgical technique addressing limitations in precision and dexterity associated with single-handed endoscopic approaches. Despite its potential, comprehensive multicentre evaluations of its outcomes remain limited.

Objective

To assess the anatomical and functional outcomes of two-handed endoscopic T1TP, considering factors like surgeon experience, perforation characteristics, and graft material selection.

Methods

This retrospective multicentre study analyzed 550 patients (aged 6–70 years) with mucosal chronic otitis media across five tertiary care centres in India. Data on demographics, perforation size/location, graft material, and pre/postoperative audiometric parameters were collected. Outcomes included graft uptake rates, air-bone gap (ABG) closure, and hearing improvement at 6 and 12 months.

Results

Overall graft uptake success rate of 94%, with small anterior perforations demonstrating superior outcomes. Younger patients (< 30 years) showed the greatest ABG reduction (20–25 dB), while improvements were lower in older age groups (> 50 years).Surgeon Experience: Closure rates increased from 78% (0–50 cases) to 97% (> 200 cases); operative duration decreased from 95 ± 8 to 72 ± 6 min with experience. Temporalis fascia and cartilage both yielded significant audiometric improvements, with cartilage providing better structural support for larger perforations.

Conclusion

Two-handed endoscopic T1TP is a transformative approach offering high anatomical and functional success rates, particularly for challenging perforations. Surgeon training, graft optimization, and tailored patient strategies are critical for maximizing outcomes.