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

Clin Otolaryngol. 2019 Nov;44(6):942-953. doi: 10.1111/coa.13407. Epub 2019 Oct 4.


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.

Keywords: cosmetics; endoscopy; myringoplasty; operative time; treatment outcome; tympanic membrane perforation; tympanoplasty.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Endoscopy*
  • Humans
  • Microsurgery*
  • Treatment Outcome
  • Tympanic Membrane Perforation / surgery*
  • Tympanoplasty*