OTOLOGY Endoscopic versus microscopic type 1 tympanoplasty in the same patients: a prospective randomized controlled trial Isa Kaya 1 • Baha Sezgin 1 • Demet Sergin 2 • Arin Ozturk 1 • Sevinc Eraslan 1 • Sercan Gode 1 • Cem Bilgen 1 • Tayfun Kirazli 1 Received: 19 April 2017 / Accepted: 27 June 2017 Ó Springer-Verlag GmbH Germany 2017 Abstract The aim of this study was to compare the audi- ologic outcomes of the patients who underwent endoscopy on one ear and microscopic tympanoplasty on the other, and to investigate the operative time, graft success, post- operative pain and health status. This prospective ran- domized controlled study was carried out in Ege University ENT Department between February 2015 and September 2016. The patients who had bilateral chronic otitis media, normal middle ear mucosa and a hearing loss difference of 10 dB or less between the two ears randomly underwent microscopic tympanoplasty in one ear and endoscopic tympanoplasty in the contralateral ear, with 6-month intervals. 13 patients were included in the study with a mean age of 36.17 ± 3.61 years (range 17–53 years, 7 female, 6 male). The improvement in air–bone gap for groups 1 (endoscopic) and 2 (microscopic) was 9.48 ± 5.23 and 9.89 ± 2.79 dB, respectively. The dura- tion of the surgery in group 1 was significantly lower than that in group 2 (p \ 0.01). VAS scores were 2.15 ± 0.37 and 3.76 ± 1.64 cm for groups 1 and 2, respectively (p = 0.006). The endoscopic approach for type 1 tym- panoplasty offers shorter surgery time, better health status and lower postoperative pain than microscopic surgery. In addition, endoscopic surgery offers comparable improve- ment in air–bone gap and similar graft success. The endoscopic approach has comparable audiological and morphological graft outcomes with the microscopic one. The endoscopic approach yielded better health and pain status for the same patients. Level of evidence This is an individual randomized controlled trial. The level of evidence is 1b. Keywords Endoscopic tympanoplasty Á Microscopic tympanoplasty Á Type 1 tympanoplasty Á Operative time Introduction Chronic otitis media is a common disease, which may have serious complications [1]. Tympanoplasty is one of the surgical procedures performed for eradication of infection and repair of the tympanic membrane [2]. Banzer was the first surgeon to repair a perforated tympanic membrane with pig’s bladder in 1640 [3]. Blake used a paper patch in 1877 and a skin graft was used by Berthold in 1878 for the first time [4, 5]. Microscopic tympanoplasty with skin graft has been the main surgical procedure since the 1950s. Canal skin pedicle grafts were used by Soon for repairing large tympanic perforation [6]. Vein grafts were used in the late 1950s [6] and House and Sheehy started using canal skin as overlay graft in the early 1960s [7]. Then the fascia graft was described by Storrs in 1961 [8]. The surgical procedure has been changed over the years and various grafting techniques have been described, which include overlay, underlay and over underlay tympanoplasty [7–9]. Microscopic tympanoplasty has been the main surgical procedure since the 1950s, but endoscopic tympanoplasty has been increasingly performed since the 1990s [10, 11]. Microscopic and endoscopic tympanoplasties have similar success rates for graft condition [12–14]. On the other hand, endoscopic surgery is less invasive, so that operative time, postoperative pain and scars are rare than & Baha Sezgin bahasezgin18@hotmail.com 1 Otorhinolaryngology Department, Ege University School of Medicine, Tip Fakultesi, KBB Anabilim Dalı, Izmir, Turkey 2 Anesthesiology and Reanimation Department, Ege University School of Medicine, Izmir, Turkey 123 Eur Arch Otorhinolaryngol DOI 10.1007/s00405-017-4661-1