Early patient-reported psychological and quality-of-life outcomes following endoscopic and microscopic tympanoplasty: A prospective comparative cohort study.

OBJECTIVE: To evaluate early postoperative patient-reported psychological and quality-of-life outcomes in patients undergoing endoscopic and microscopic tympanoplasty within a prospective non-randomized comparative cohort. METHODS: A prospective comparative study was conducted in 50 adults with mucosal-type chronic otitis media undergoing type I tympanoplasty at two tertiary referral centres (endoscopic, n = 25; microscopic, n = 25). Allocation to surgical approach was determined by institutional operating practice and surgeon assignment rather than randomization. Psychological status and disease-specific quality of life were assessed preoperatively and at outpatient follow-up 2 months postoperatively (±2 weeks) using validated versions of the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Chronic Otitis Media Questionnaire-12 (COMQ-12). Audiological outcomes were evaluated based on air-bone gap (ABG). Postoperative recovery parameters, including duration of hospitalization, return to work, cosmetic satisfaction, and subjective hearing perception, were additionally recorded. Analyses were exploratory and unadjusted. RESULTS: Fifty participants were included. No statistically significant differences were observed between groups in baseline demographic characteristics, preoperative audiological findings, or baseline patient-reported outcome measures. At 2 months, the endoscopic cohort demonstrated lower mean anxiety scores (5.4 ± 1.9 vs 8.6 ± 2.1; p < 0.001), lower depression scores (5.1 ± 1.8 vs 7.9 ± 2.2; p < 0.001), and lower COMQ-12 scores (17.2 ± 4.0 vs 24.6 ± 4.7; p < 0.001) compared with the microscopic cohort. Greater reductions were observed in GAD-7 scores (-9.8 ± 2.3 vs -7.9 ± 2.2; p = 0.005) and COMQ-12 scores (-21.7 ± 4.4 vs -18.6 ± 4.5; p = 0.018), whereas the reduction in PHQ-9 scores did not differ significantly between groups (-11.0 ± 2.3 vs -9.7 ± 2.4; p = 0.06). Audiological improvement as per ABG was comparable between groups (7.8 ± 1.0 vs 7.3 ± 0.9 dB; p = 0.07). Patients managed within the endoscopic group also had shorter hospitalization and higher cosmetic satisfaction scores (both p < 0.001). CONCLUSION: Patients in the endoscopic cohort reported more favorable early psychological and disease-specific quality-of-life outcomes, while short-term audiological improvement, as assessed by air-bone gap closure, was similar between cohorts. Given the non-randomized design, institution-level confounding, absence of detailed disease-specific baseline variables, and short follow-up duration, these findings should be interpreted as associative and exploratory rather than evidence of technique-specific superiority. The study highlights the value of incorporating patient-reported outcome measures alongside conventional audiological assessments in tympanoplasty evaluation.