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

Abstract

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

Outcomes After Exoscopic Versus Microscopic Type 1 Tympanoplasty

“…This study demonstrated high rates of graft success (91%) after type 1 exoscopic and microscopic tympanoplasty at 6 months postoperatively. These rates are equal to if not better than the rates reported in the literature (5). Overall, this study demonstrates that in the hands of a capable surgeon, both exoscopic and microscopic type 1 tympanoplasty can be highly successful.…”

Cholesteatoma Severity Determines the Risk of Recurrent Paediatric Cholesteatoma More Than the Surgical Approach

“…Thus, although mastoid obliteration has been touted as a means to minimise recurrence in children, it is clear from the current series that when using obliteration for more severe paediatric cholesteatoma, the prevention of recurrence cannot be guaranteed. Recognising that trans-canal endoscopic surgery has significantly less post-operative morbidity than post-auricular surgery [41], that use of endoscopes reduces the risk of residual cholesteatoma [42] while maintaining equivalent perforation closure rates [43], and that there is an improvement in hearing from ossiculoplasty [44], the lack of any detectable difference in recurrence rates with this approach suggests that, when possible, paediatric cholesteatoma should be removed using this approach. More extensive disease will continue to need trans-mastoid surgery with or without mastoid obliteration.…”

Comparison of Endoscopic Ear Surgery and Microscopic Ear Surgery in Patients With Attic Cholesteatoma

“…However, a study comparing endoscopic and microscopic approach in cholesteatoma surgery confirmed that EES is safe and both the approaches have comparable results (Panetti et al, 2017). A review study suggested that limited prospective and comparative papers on MES vs EES, several aspects remain debatable (Crotty et al, 2023). This prospective study was conducted to compare MES with EES in patients with attic cholesteatoma, particularly we evaluate intraoperative characteristics and surgical outcomes of both procedures.…”