Comparison of endoscope-assisted and microscope-assisted type I tympanoplasty; a systematic review and meta-analysis.

Objectives: To analyze and compare the available data about the outcomes of endoscopic and microscopic type I tympanoplasty. Data sources: PubMed, Cochrane library Ovid, Scopus, Google scholar, and ClinicalTrials. Methods: We conducted a meta-analysis in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We included comparative studies describing type I tympanoplasty, and comparing surgical outcomes of the endoscope with the microscope in terms of efficacy and safety. Results: Our systematic search yielded 22 studies meeting the inclusion criteria and eligible for analysis. The pooled graft uptake rates and audiological results of endoscopic and microscopic tympanoplasty demonstrated non-significant differences. In contrast, endoscopic type I tympanoplasty outperforms microscopic tympanoplasty regarding a highly significant decrease not only in pooled mean operative time but also in the pooled complications rate. Conclusions: Based on our meta-analysis, the surgical outcomes of endoscope-assisted and microscope-assisted type I tympanoplasty in terms of postoperative hearing outcomes and the graft uptake rate were comparable. On the contrary, operative time and complications rate proved to be significantly reduced with endoscopy compared to microscopy. Hence, the endoscope is as efficient as the microscope in type I tympanoplasty but less invasive, fewer in complications and shorter in operative time. Key Points: Can the endoscope be a good alternative to the microscope in type I tympanoplasty? Using the microscope in tympanoplasty has been the conventional procedure for repairing perforated tympanic membranes since the 1950s. However, ear surgeons have increasingly practised endoscope-assisted tympanoplasty since the late 1990s. In this study, surgical outcomes of both techniques in terms of postoperative audiological results and the graft uptake rate were comparable. In contrast, the endoscopic technique was superior to the microscopic one in terms of operative time and complications rate. According to our study, the endoscope-Assisted type I tympanoplasty proved to be as effective as the microscopic technique but safer and less invasive. [ABSTRACT FROM AUTHOR]