Endoscopic Type I Tympanoplasty is as Effective as Microscopic Type I Tympanoplasty but Less Invasive – a Meta‐Analysis
István Pap  István Tóth  Noémi Gede  Péter Hegyi  Zsolt Szakács  Alexandros Koukkoullis  Péter Révész  Kinga Harmat  Adrienne Németh  László Lujber  Imre Gerlinger … See all authors
First published: 29 July 2019 https://doi.org/10.1111/coa.13407
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/coa.13407
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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 is 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 among 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.