• Objective: To evaluate the anatomical and functional outcomes of a novel grafting modification: endoscopic annular chondroperichondrial tympanoplasty.

• Methods: This retrospective study evaluated 40 chronic otitis media patients operated on between 2015 and 2022. Tragal cartilage was harvested, its center was circularly excised to leave a 2–3 mm ring, and a 1 mm peripheral perichondrial edge was engineered along with a malleus slot. Grafts were placed via a transcanal endoscopic approach using the under-over technique.

• Results: The overall graft integration rate was 95% (38/40 intact grafts) at the 6-month follow-up. The mean preoperative PTA-ABG significantly improved from 22.1 dB to 5.7 dB postoperatively (p < 0.05), yielding a mean closure of 16.4 dB. No major complications were noted.

• Conclusion: This novel modification bridges the gap between acoustic excellence and structural stability, offering high anatomical success and optimal hearing reconstruction in modern otology.

Title: Transcanal Endoscopic Cholesteatoma Surgery: Advantages, Limitations, and Pushing the Technical Boundaries

Objective: Transcanal Endoscopic Ear Surgery (TEES) has revolutionized the management of middle ear cholesteatoma by offering unprecedented access to hidden recesses. This presentation aims to evaluate the clinical advantages, inherent drawbacks, and technical limitations of exclusive endoscopic cholesteatoma surgery, while highlighting contemporary boundary-pushing techniques that expand its indications in complex cases.

Methods: The surgical principles and clinical outcomes of TEES in cholesteatoma eradication were systematically analyzed. The focus was placed on the direct visualization of critical areas such as the sinus tympani, facial recess, and anterior epitympanum. Additionally, the presentation reviews advanced technical solutions—including customized structural graft modifications and modified attic reconstructions—designed to overcome traditional endoscopic constraints and prevent retraction pockets.

Results: The primary advantage of TEES in cholesteatoma treatment is its superior, wide-angle panoramic visualization, which facilitates complete disease eradication from deep recesses without the morbidity of extensive canalplasty or retroauricular mastoidectomy. This minimally invasive transcanal approach significantly reduces postoperative pain and ensures excellent cosmetic outcomes. However, the loss of binocular depth perception and the strict requirement for one-handed surgery remain major drawbacks, particularly during active bleeding. While narrow pediatric external auditory canals traditionally limit instrument maneuverability, contemporary boundary-pushing innovations—such as the utilization of highly pliable, customized annular chondroperichondrial grafts—successfully overcome structural limitations, preventing post-operative retractions while facilitating single-handed graft management even in complex reconstructions.

Conclusion: TEES is a highly effective, minimally invasive alternative that offers unmatched visualization for complete cholesteatoma eradication. While the one-handed learning curve demands structured training, this presentation underlines that understanding technical limits, while actively implementing innovations that push these boundaries, is paramount for expanding patient selection and achieving long-term surgical success without recurrence.