Endoscopic Versus Microscopic Type‐1 Tympanoplasty: A Meta‐Analysis of Randomized Trials

Objectives Totally endoscopic ear surgery is becoming increasingly utilized in otologic practice. Although the well‐established microscope‐assisted tympanoplasty remains the most common technique to repair a tympanic membrane defect, the merits of endoscopic approaches have been well‐documented. This systematic review and meta‐analysis compares the outcomes of endoscopic to microscopic tympanoplasty incorporating only randomized trials. Study Design Systematic review and meta‐analysis. Methods A comprehensive search of PubMed/MEDLINE, Scopus, Cochrane Library, and EMBASE was conducted. All randomized studies comparing endoscopic to microscopic tympanoplasty were collected according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines. Quality assessment was carried out utilizing the Risk of Bias 2. Results The initial search identified 1711 studies, of which 9 met the inclusion criteria comprising of 540 patients (microscopic tympanoplasty 51.5%; endoscopic tympanoplasty 49.5%). The mean age was 32.5 years with a similar number of males (50.1%) and females (49.9%). Both endoscopic and microscopic groups had comparable outcomes with regards to graft success rate (RD 0.00; 95% confidence interval [CI], −0.04 to. 0.05; p = 0.87) and hearing improvement (MD 0.57 dB; 95% CI, −1.23 to 2.36; p = 0.54). A significantly shorter operative time was noted in the endoscopic group (MD, −24.73 min; 95% CI, −38.56 to −10.89; p = 0.0005). Conclusion Our results, assimilating level 1 evidence, demonstrates that endoscopic and microscopic‐assisted type‐1 tympanoplasty have similar outcomes in both graft success and hearing improvement, with endoscopic approaches yielding a shorter operative time. Level of Evidence 1 Laryngoscope, 133:1550–1557, 2023 Although microscope‐assisted tympanoplasty remains the gold standard, the merits of endoscopic approaches have been well‐documented. This meta‐analysis compares the outcomes of endoscopic to microscopic tympanoplasty incorporating only randomized trials. The result from this meta‐analysis provides level 1 evidence demonstrating that endoscopic and microscopic‐assisted type‐1 tympanoplasty have similar outcomes in both graft success and hearing improvement, with endoscopic approaches yielding a shorter operative time.