Endoscopic Versus Microscopic Tympanoplasty: A Systematic Review and Metanalysis.

Objective: Endoscopic ear surgery is no longer a promising technique, but a well-established one. This study aims to compare endoscopic and microscopic tympanoplasty based on current literature evidence, in terms of their efficacy and safety characteristics.
Data Sources: We conducted a systematic literature search of four medical databases (Pubmed, Cochrane Library, Scopus, ClinicalTrials.gov), focusing on randomized controlled or observational studies comparing microscopic to endoscopic tympanoplasty.
Review Methods: Data related to the efficacy and safety of each technique were extracted. Outcome data were summarized using pooled mean differences or pooled odds ratio along with their 95% confidence intervals. The risk of bias was estimated, by using the ROBINS-I and RoB-II assessment tools, while the overall quality of evidence was evaluated according to the GRADE working group.
Results: Thirty-three studies, with 2646 patients in total, were included in the meta-analysis. Success rate was evaluated by estimating tympanic graft failure (pooled mean difference:-0.23; 95% CI: -0.61, 0.14, I ²  = 33.42%), and air-bone gap improvement (pooled mean difference:-0.05; 95% CI:-0.23, 0.13, I ²  = 52.69%), resulting in comparable outcomes for the two techniques. A statistically significant difference favoring the endoscopic technique was detected regarding postoperative wound infection (OR: -1.72; 95% CI: -3.39, -0.04, I ²  = 0%), dysgeusia (OR: -1.47; 95% CI: -2.47, -0.47, I ²  = 0%), otitis externa development (OR: -1.96; 95% CI: -3.23, -0.69, I ²  = 0%), auricular numbness (OR: -2.56; 95% CI: -3.93, -1.19, I ²  = 0%), as well as surgical duration (OR: -1.86; 95% CI: -2.70, -1.02, I ²  = 43.95%), when compared to the postauricular microscopic approach.
Conclusion: Endoscopic tympanoplasty is an innovative alternative to the microscopic technique, resulting in commensurate outcomes regarding success rate. Furthermore, it offers superior results concerning postoperative complications, while it presents a significant reduction in the duration of surgery, mainly when it is compared to the postauricular microscopic approach.
Level of Evidence: NA Laryngoscope, 134:3466-3476, 2024.
(© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)