Abstract:Objective To explore a novel method of "four-point fixation" endoscopic myringoplasty with temporal muscle fascia and its clinical efficacy.Methods A total of 19 patients with large anterior or central perforation of tympanic membrane underwent endoscopic myringoplasty at the Peking University Third Hospital from Oct 2020 to June 2021 were included. and divided into two groups. In observation group, 12 ears (10 cases) were repaired with temporal muscle fascia via "four-point fixation" method, and 9 ears (9 cases) in the control group with tragus cartilage with perichondrium under endoscope. Objective evaluation was carried out by endoscopy and pure tone audiometry 3 months postoperatively. Chinese version of the Zurich Chronic Middle Ear Invertory (ZCMEI) was used to evaluate the quality of life of the two groups from four aspects, including otitis media symptoms, postoperative subjective hearing level, psychosocial impact and medical resources occupation.Results The graft success rate was 100% in the observation group, and the shape of eardrum was closer to normal shallow concave shape. In the control group, the success rate was 88.9% with front fissure perforation in one case. In the observation group, the postoperative pure tone average (PTA) and air-bone gap (ABG) were (22.5±7.5) dB and (10.0±8.2) dB respectively, which were significantly higher than the preoperative ones[(35.1±12.6) dB and (21.7±8.2)dB,(P=0.009, P=0.011)]. The postoperative air conductances of the observation group at 0.25 k, 0.5 k and 1 kHz were significantly improved, while the postoperative air conductance was significantly improved only at 0.25 kHz in the control group. In terms of quality of life score, there were no significant differences between the two groups in otitis media symptoms, postoperative subjective hearing level, psychosocial impact and medical resource occupation (P>0.05).Conclusion With advantages of high graft success rate, natural shape of the postoperative eardrum and good hearing improvement, "four-point fixation" endoscopic myringoplasty with temporal muscle fascia can be used for tympanic membrane repair in patients with large ear canal, anterior tympanic membrane perforation and high requirement for postoperative hearing improvement.