Endoscopic type I tympanoplasty is as effective as microscopic type I tympanoplasty but less invasive—A meta‐analysis

Abstract

Background Endoscopic type I tympanoplasty was originally introduced in the 1990s, and the extensive spread of this practice can be easily observed. The conventional technique performed involves the repair of a tympanic membrane perforation, and is defined as microscopic type I tympanoplasty. Objective of Review The aim of this study was the comparison of postoperative outcomes of both the endoscopic and the microscopic type I tympanoplasty. Type of Review We conducted a meta‐analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐analysis (PRISMA) guidelines. Search Strategy A systematic literature search was performed in the databases of PubMed, Embase, Cochrane Library, Clarivate Analytics‐Web of Science, ClinicalTrials.gov, World Health Organization Library, and Scopus by inserting, ‘myringoplasty OR (tympanoplasty AND perforation)’ into the search query. We applied only a ‘human’ filter. We excluded non‐English studies. Additional records were identified by checking the references of relevant studies. Evaluation Method Comparative studies were included in our analysis. We calculated the pooled odds ratio (OR) with 95% confidence interval (CI) for dichotomous outcomes and weighted mean difference (WMD) with a 95% CI for continuous outcomes. Additionally, we assessed the risk of bias and estimated the quality of evidence for each outcome. Results Our systematic search yielded 16 studies (involving 1179 interventions), eligible for analysis. The pooled graft uptake rate (OR: 1.21, CI: 0.82‐1.77; I2 = 0.0%), the postoperative hearing results (WMD = −1.13; 95% CI: −2.72‐0.45; I2 = 78.1%) and the operation time (WMD = −21.11; 95% CI: −42.60‐0.38; I2 = 99.3%), were all comparable amongst the two techniques. In contrast, the endoscopic type I tympanoplasty outperforms when regarding the pooled canaloplasty rate (OR = 7.96; 95% CI: 4.30‐14.76; I2 = 0.0%, P = 1.000) and features an increase in desirable cosmetic results (OR = 19.29; 95% CI: 11.37‐32.73; I2 = 0.0%, P = 0.839), when compared with the microscopic approach. Conclusions Based on our meta‐analysis, the surgical outcomes of endoscopic type I tympanoplasty in terms of graft uptake rate, postoperative hearing results and operation time were comparable to the microscopic type I tympanoplasty. In regards to cosmetics, an increase in desirable results was achieved in the endoscopic group, particularly the incidence of canaloplasty which proved to be significantly lower.

Comparison of Endoscope-Assisted and Microscope-Assisted Type 1 Tympanoplasty; A Systematic Review and Meta-analysis

“…With regard to the graft uptake, no significant difference was found between ET and MT. Similar results were also reported in previous meta-analytic studies of Tseng C-C et al 34 , Lee S-Y et al 35 and Pap I et al 36 . In this meta-analysis, we selected included studies that used similar operative techniques such as grafting material (temporalis fascia or perichondrium) and the graft placement method by underlay technique in order to obtain more accurate results about graft uptake rate.…”

Underlay Versus Modified Circumferential Subannular Graft Technique in Endoscopic Tympanoplasty

“…The reported graft success rates of tympanoplasty vary between studies, but a meta-analysis by Pap, et al 16) showed that the graft uptake rate of endoscopic tympanoplasty was 86.9% (159/183) in randomized controlled trials and that the overall average success rate was 90.5% (503/556). A microscopic tympanoplasty success rate of 89.0% (163/183) was achieved in randomized controlled trials, and of 88.3% (550/623) in overall cases.…”

Comparative study of outcomes of type 1 tympanoplasty with and without anterior tucking

“…7,8 Various studies have been done comparing the conventional microscopic postauricular approach and endoscopic transcanal approach for TM repair with comparable outcomes with regard to graft success and hearing gain and the endoscopic method having additional advantages of anterior margin visibility, minimal invasiveness, lesser operative time, lesser postoperative pain and better cosmesis. [9][10][11][12][13][14] Regarding the size, large and subtotal perforations have lesser rates of success of graft uptake whereas in terms of the site, anterior and marginal perforations have been reported for having a negative impact over the success of type-1 tympanoplasty. [15][16][17] There are numerous studies highlighting the problematic anterior quadrant perforation repair for which several modified techniques and methods have been incorporated like the Gerlach quilt method, anterior hitch method, Kerr flap technique, 360degree subannular tympanoplasty, anterior interlay myringoplasty, window shade technique, circumferential flap method and anterior tucking technique.…”