Endoscopic Versus Microscopic Type I Tympanoplasty: An Updated Systematic Review and Meta‐analysis

Abstract Objective Our objective was to perform a systematic review and meta‐analysis comparing the clinical outcomes after endoscopic and microscopic type I tympanoplasty. Study Design Randomized controlled trials, two‐arm prospective studies, and retrospective studies were included. Setting Medline, Cochrane, EMBASE, and Google Scholar databases were searched until March 1, 2022 using the combinations of search terms: “endoscopic,” “microscopic,” and “tympanoplasty.” Methods Two independent reviewers utilized the abovementioned search strategy to identify eligible studies. If any uncertainty existed regarding eligibility, a third reviewer was consulted. Primary outcome measures were graft success rate, air‐bone gap (ABG) improvement, and operative time. Secondary outcomes were the rate of need for canalplasty, the proportion of self‐rated excellent cosmetic results, and pain visual analog scale (VAS). Results Forty‐three studies enrolled a total of 3712 patients who were undergoing type I tympanoplasty and were finally included. The pooled result showed endoscopic approach was significantly associated with shorter operative time (difference in means: −20.021, 95% confidence interval [CI]: −31.431 to −8.611), less need for canalplasty (odds ratio [OR]: 0.065, 95% CI: 0.026‐0.164), more self‐rated excellent cosmetic results (OR: 87.323, 95% CI: 26.750‐285.063), and lower pain VAS (difference in means: −2.513, 95% CI: −4.737 to −0.228). No significant differences in graft success rate or ABG were observed between the two procedures. Conclusion Endoscopic type I tympanoplasty provides a similar graft success rate, improvement in ABG, and reperforation rate to microscopic tympanoplasty with a shorter operative time, better self‐rated cosmetic results, and less pain. Unless contraindicated, the endoscopic approach should be the procedure of choice in type I tympanoplasty.