Comparison of endoscopic butterfly inlay cartilage myringoplasty and microscopic over-underlay cartilage tympanoplasty in the repair of tympanic membrane perforations

OBJECTIVES: This study compared endoscopic butterfly inlay and microscopic over-underlay cartilage tympanoplasty regarding graft success and hearing outcomes. METHODS: A retrospective analysis was performed on patients who underwent tympanoplasty between January 2022 and December 2024. Patients with additional otologic procedures, cholesteatoma or revision surgery were excluded. Patients were assigned to Group 1 (endoscopic butterfly inlay) or Group 2 (microscopic over-underlay). Demographic characteristics, perforation size, operative time, graft success and audiometric outcomes were evaluated using air-bone gap (ABG). RESULTS: Sixty-four patients were included (33 in Group 1, 31 in Group 2). Operative time was significantly longer in the microscopic group, while perforation size and graft success rates were similar. Both techniques resulted in significant post-operative hearing improvement without inter-group differences. CONCLUSION: Both techniques provided comparable graft success and hearing outcomes. The endoscopic butterfly inlay technique achieved similar results with shorter operative time, supporting its use as a minimally invasive alternative.