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

Tang-Chuan Wang^1,2,3,4, Tzu-Ching Shih⁵, Chin-Kuo Chen⁶

¹Department of Otolaryngology-Head and Neck Surgery, Hsinchu Hospital, China Medical University, Hsinchu, Taiwan.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery

|December 23, 2023

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Endoscopic tympanoplasty offers similar graft success and hearing improvement to microscopic approaches. However, it significantly reduces operative time, pain, and improves cosmetic outcomes, making it the preferred choice.

Area of Science:

Otolaryngology
Minimally Invasive Surgery

Background:

Type I tympanoplasty is a common surgical procedure to repair eardrum perforations.
Both endoscopic and microscopic techniques are utilized, each with potential advantages.

Purpose of the Study:

To systematically review and meta-analyze clinical outcomes comparing endoscopic and microscopic type I tympanoplasty.
To determine the superior approach based on graft success, hearing improvement, operative time, and patient-reported outcomes.

Main Methods:

Systematic review and meta-analysis of randomized controlled trials, prospective, and retrospective studies.
Searched Medline, Cochrane, EMBASE, and Google Scholar databases up to March 1, 2022.
Primary outcomes: graft success, air-bone gap (ABG) improvement, operative time. Secondary outcomes: canalplasty, cosmetic results, pain (VAS).

Keywords:

endoscopic microscopic otological surgical procedures tympanoplasty

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Main Results:

Analysis of 43 studies with 3712 patients.
Endoscopic tympanoplasty showed significantly shorter operative time, less need for canalplasty, better cosmetic results, and lower pain scores.
No significant differences were found in graft success rate or ABG improvement between endoscopic and microscopic approaches.

Conclusions:

Endoscopic type I tympanoplasty demonstrates comparable graft success and hearing outcomes to the microscopic technique.
The endoscopic approach offers advantages in reduced operative time, improved cosmesis, and decreased postoperative pain.
Endoscopic tympanoplasty is recommended as the procedure of choice for type I tympanoplasty when not contraindicated.