Endoscopic Versus Microscopic Tympanoplasty: A Systematic Review and Metanalysis

Eleni Gkrinia; Anna Maria Ntziovara; Alexandros G Brotis; Konstantinos Tzimkas-Dakis; Athanasios Saratziotis; Christos Korais; Jiannis Hajiioannou

doi:10.1002/lary.31365

Endoscopic Versus Microscopic Tympanoplasty: A Systematic Review and Metanalysis

Laryngoscope. 2024 Feb 28. doi: 10.1002/lary.31365. Online ahead of print.

Authors

Eleni Gkrinia¹, Anna Maria Ntziovara¹, Alexandros G Brotis², Konstantinos Tzimkas-Dakis¹, Athanasios Saratziotis¹, Christos Korais¹, Jiannis Hajiioannou¹

Affiliations

¹ ENT Department, University Hospital of Larissa, Larisa, Greece.
² Department of Neurosurgery, University Hospital of Larissa, Larisa, Greece.

PMID: 38415937
DOI: 10.1002/lary.31365

Abstract

Objective: Endoscopic ear surgery is no longer a promising technique, but a well-established one. This study aims to compare endoscopic and microscopic tympanoplasty based on current literature evidence, in terms of their efficacy and safety characteristics.

Data sources: We conducted a systematic literature search of four medical databases (Pubmed, Cochrane Library, Scopus, ClinicalTrials.gov), focusing on randomized controlled or observational studies comparing microscopic to endoscopic tympanoplasty.

Review methods: Data related to the efficacy and safety of each technique were extracted. Outcome data were summarized using pooled mean differences or pooled odds ratio along with their 95% confidence intervals. The risk of bias was estimated, by using the ROBINS-I and RoB-II assessment tools, while the overall quality of evidence was evaluated according to the GRADE working group.

Results: Thirty-three studies, with 2646 patients in total, were included in the meta-analysis. Success rate was evaluated by estimating tympanic graft failure (pooled mean difference:-0.23; 95% CI: -0.61, 0.14, I² = 33.42%), and air-bone gap improvement (pooled mean difference:-0.05; 95% CI:-0.23, 0.13, I² = 52.69%), resulting in comparable outcomes for the two techniques. A statistically significant difference favoring the endoscopic technique was detected regarding postoperative wound infection (OR: -1.72; 95% CI: -3.39, -0.04, I² = 0%), dysgeusia (OR: -1.47; 95% CI: -2.47, -0.47, I² = 0%), otitis externa development (OR: -1.96; 95% CI: -3.23, -0.69, I² = 0%), auricular numbness (OR: -2.56; 95% CI: -3.93, -1.19, I² = 0%), as well as surgical duration (OR: -1.86; 95% CI: -2.70, -1.02, I² = 43.95%), when compared to the postauricular microscopic approach.

Conclusion: Endoscopic tympanoplasty is an innovative alternative to the microscopic technique, resulting in commensurate outcomes regarding success rate. Furthermore, it offers superior results concerning postoperative complications, while it presents a significant reduction in the duration of surgery, mainly when it is compared to the postauricular microscopic approach.

Level of evidence: NA Laryngoscope, 2024.

Keywords: chronic otitis media; endoscopy; microscopy; otology; tympanic membrane perforation; tympanoplasty.

Publication types

Review