Endoscopic tympanoplasty type I with composite perichondrium-cartilage graft in children: surgical and audiologic outcomes from an Italian cohort

Endoscopic Type I tympanoplasty (TPL I) represent a minimally invasive surgery to treat tympanic membrane perforation. Its role in the pediatric population remains under-evaluated. A retrospective study was conducted on 46 pediatric patients undergoing exclusive endoscopic TPL I with a full-thickness tragal cartilage-perichondrium graft between 2021 and 2024. Surgical outcomes, audiological improvements, and complication rates were assessed at a tertiary Italian center. Anatomical success was achieved in 89.1% of cases, with no major intraoperative and postoperative complications. The mean postoperative air-bone gap significantly improved from 18.0 dB to 10.18 dB. Functional success (ABG ≤20 dB) was recorded in 87% of patients. Failures were more frequent among patients operated on by junior surgeons and in anterior and marginal perforations. Endoscopic TPL I with a composite cartilage-perichondrium graft is a safe and effective option in pediatric patients, providing excellent anatomical and functional outcomes with minimal complications.