Comparison of the efficacy of endoscopic tympanoplasty and microscopic tympanoplasty: A systematic review and meta‐analysis

Tseng, Chih Chieh; Lai, Ming‐Tang; Wu, Chia Che; Yuan, Shengtao; Ding, Yi

doi:10.1002/lary.26379

Cited by 120 publications

(116 citation statements)

References 27 publications

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“…Our findings were similar to those presented in the previously published meta‐analysis. In contrast to the former publication, specifically regarding this topic, the present search yielded an additional three more randomised controlled trials which allowed us to arrange subgroups of RCTs. To rate the evidence of every statement, the GRADE approach was used (Table ).…”

Section: Discussionmentioning

confidence: 99%

“…In 2016, a superbly written meta-analysis was published which collected evidence regarding both endoscopic and microscopic type I tympanoplasty. 7 Since this topic is of particularly high interest, several new studies, including high-quality randomised controlled trials (RCTs), have been recently published. The large body of evidence accumulated proved inspirational, resulting in our intensive review of the plethora of recently published literature.…”

Section: Objectivesmentioning

confidence: 99%

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

Pap

Tóth

Gede

et al. 2019

Clinical Otolaryngology

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Objectivesmentioning

confidence: 99%

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

Pap

Tóth

Gede

et al. 2019

Clinical Otolaryngology

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“…18 In the present study, patients were between 15-55 years of age. The most common age group of patients in our study was the third decade ( 19 They found that pooled canalplasty rate of endoscopic tympanoplasty was significantly lower than that of microscopic tympanoplasty. Patients undergoing endoscopic tympanoplasty had a more desirable cosmetic result than with microscopic tympanoplasty.…”

Section: Discussionmentioning

confidence: 62%

Comparison of endoscopic underlay and microscopic underlay tympanoplasty: a prospective research at a tertiary care centre in Gujarat

Sinha

Hirani

Khilnani

2017

Int J Otorhinolaryngol Head Neck Surg

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Background: Tympanoplasty is an ever evolving surgery with myriad of approaches and tools. Use of endoscope is relatively new and there are few studies evaluating the use of endoscope via microscope because of a big learning curve in using one hand endoscopic technique despite it being minimally invasive.Methods: This is a prospective study conducted from June 2016 to May 2017 with a sample size of 44 patients. The study included patients of Chronic Otitis Media (COM) of mucosal inactive type without any co-morbidities in which only Type-1 tympanoplasty was done. The patients were divided into endoscopic or microscopic group using simple random sampling and after taking written and informed consent. The patient’s details regarding audiometric, oto-endoscopic and nasal endoscopic evaluation were recorded. Intra operative findings, duration of surgery and post-operative pain scoring were recorded. The patients were followed up for 3 months and subjected to post-operative audiometry and patient satisfaction questionnaire. The groups were evaluated for graft take up and closure of air bone gap, post-operative complications and patient satisfaction. The results were analysed using descriptive statistics (mean and percentage) and CHISQ test.Results: Graft was taken up in 21 patients (95%) in microscopic as opposed to 20 in endoscopic group (90%). Mean VAS scoring for pain was 2.5 in microscopic group on first post-operative day and 1.5 for the endoscopic group. The mean improvement in air bone gap post-surgery was 23.68 dB (SD=4.94) for microscopic group and 16.13 dB (SD=6.49) for endoscopic group.Conclusions: Endoscopic tympanoplasty as a technique has a long learning curve. The results indicate that endoscopic technique is as efficacious as and less invasive than microscope surgery for doing tympanoplasty.

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“…[1,3,10,11] Two systematic reviews revealed that graft survival rate and hearing outcomes following ET were comparable with CMT. [12,15] In the qualitative analysis of Lee et al [15] , the graft survival rate in ET ranged from 83% to 100%, which was similar to that in CMT according to the studies included in their meta-analysis. The graft survival rate seems to be affected by the grafting technique rather than the type of surgical approach, although most of the studies regarding the outcomes of ET utilized an underlay grafting technique during ET, which may constitute a potential publication bias [15] .…”

Section: Discussionmentioning

confidence: 82%

“…[7][8][9] In recent studies, ET has also been demonstrated with favorable results as a minimally invasive surgery. [10][11][12] ET enables a wider view with varying angles of view, and does not require canalplasty, postauricular incision and general anesthesia; hence, the operative time is shorter than with conventional techniques. The minimally invasive nature of gery is usually affected by the width, tortuosity and bony overhangs of the ear canal, therefore canalplasty is often performed to improve the vision.…”

Section: Introductionmentioning

confidence: 99%

How do you perform your tympanoplasty, endoscopically or microscopically?

Bayram¹,

Marchioni²,

Peng³

et al. 2019

ENT Updates

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Since the introduction of endoscopic ear surgery (EES) in the 1990s, endoscopic systems have been utilized in a number of ear surgeries including myringoplasty and tympanoplasty. Endoscopic tympanoplasty (ET) is described as a minimally invasive surgery for surgical repair of the tympanic membrane (TM) with comparable graft survival and hearing outcomes to conventional microscopic surgery (CMT). In the present review, we aimed to outline the surgical benefits and potential drawbacks of ET with clinical outcomes in order to determine whether ET constitutes a proper alternative to CMT.

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Comparison of the efficacy of endoscopic tympanoplasty and microscopic tympanoplasty: A systematic review and meta‐analysis

Cited by 120 publications

References 27 publications

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

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

Comparison of endoscopic underlay and microscopic underlay tympanoplasty: a prospective research at a tertiary care centre in Gujarat

How do you perform your tympanoplasty, endoscopically or microscopically?

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