Endoscopic or microscopic tympanoplasty, which is better for repairing tympanic membrane defect? Study sheds light

Ireland: Findings from a systematic review and meta-analysis comprising only randomized trials provide level 1 evidence supporting that endoscopic tympanoplasty (ET) is similar to microscopic tympanoplasty (MT) concerning graft success and hearing outcomes. 

The study, published in The Laryngoscope, additionally found operative time for endoscopic techniques to be shorter which reduces both patients' exposure to general anaesthetic and cuts down healthcare resource utilization. The results indicate that an endoscopic approach may be preferable while performing type-1 tympanoplasty.

In otologic practice, totally endoscopic ear surgery is being increasingly utilized. For repairing a tympanic membrane defect, the well-established microscope-assisted tympanoplasty remains the most common technique but the merits of endoscopic approaches have been well-documented.

Recent studies comparing endoscopic and microscopic tympanoplasty have shown similar success rates with regard to graft uptake and postoperative closure of the air-bone gap. Also, the ET has an improved cosmetic outcome, a shorter operative time, and reduced hospital stay. Despite the increasing evidence supporting ET, the vast majority of data are retrospective and must be explained. One weakness of systematic review and meta-analyses is that the evidence level in any systematic review and meta-analysis is limited by the lowest level of evidence within the included studies. Well-performed randomized control trials (RCTs) constitute the highest level of evidence for original studies and are considered the criterion for evidence within the medical literature. 

Against the above background, Thomas J. Crotty, University Hospital Galway, Galway, Ireland, and colleagues aimed to compare the outcomes of endoscopic to microscopic tympanoplasty including only randomized trials. 

For this purpose, the researchers conducted a comprehensive search of online databases. All randomized trials comparing endoscopic to microscopic tympanoplasty were included. The Risk of Bias 2 was utilized for conducting the quality assessment. 

"Our results, assimilating level 1 evidence, showed that endoscopic and microscopic-assisted type-1 tympanoplasty have comparable outcomes in both graft success and hearing improvement, with endoscopic approaches yielding a shorter operative time," the authors concluded. 

Reference:

Crotty TJ, Cleere EF, Keogh IJ. Endoscopic Versus Microscopic Type-1 Tympanoplasty: A Meta-Analysis of Randomized Trials. Laryngoscope. 2022 Nov 9. doi: 10.1002/lary.30479. Epub ahead of print. PMID: 36349835.