Clin Exp Otorhinolaryngol.  2019 May;12(2):145-155. 10.21053/ceo.2018.01277.

Can Endoscopic Tympanoplasty Be a Good Alternative to Microscopic Tympanoplasty? A Systematic Review and Meta-Analysis

  • 1Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.


Although efficacies and proportions of tympanoplasty performed via endoscopic ear surgery (EES) have gradually introduced, it remains unclear whether total EES is a good alternative to microscopic ear surgery (MES). Herein, we aimed to compare therapeutic effects of EES and MES in patients receiving tympanoplasty or myringoplasty. A search of MEDLINE, PubMed, and Embase databases was conducted to compare the efficacies of EES and MES. Two investigators independently reviewed all studies and extracted data with a standardized form. We assessed risk of bias and calculated pooled odds ratio (OR) estimates with a 95% confidence interval (CI). Thirteen studies (607 EES patients and 678 MES patients) met inclusion criteria for quantitative meta-analysis. In pooled analysis, those who undergo EES have 0.99 times the OR of graft success compared to those with MES (95% CI, 0.84 to 1.16; P=0.894). In qualitative analysis, comparable hearing improvement was observed between the two groups, despite inconsistent audiometric evaluation. The air-bone gaps (ABGs) improved 2.02 dB less in EES than in MES (mean difference of improvements of ABGs, 2.02; 95% CI, -3.84 to -0.20; P=0.029); however, substantial heterogeneity and publication bias limited the integrity of this analysis. Further, EES significantly decreased canalplasty rate, wound complications, and operation time, compared to MES. Moreover, patients receiving EES reported higher cosmetic satisfaction than patients receiving MES. EES can be a good alternative to MES in terms of comparable graft success rate and hearing outcomes in patients receiving tympanoplasty or myringoplasty. Moreover, EES was less invasive, resulting in higher cosmetic satisfaction, reduced morbidity, and shorter operation time. Our results may affect decision-making and outcome prediction in cases of EES; however, confirmation is needed to clarify potential bias.


Endoscopes; Tympanoplasty; Myringoplasty; Review

MeSH Terms

Bias (Epidemiology)
Odds Ratio
Population Characteristics
Publication Bias
Research Personnel
Therapeutic Uses
Wounds and Injuries
Therapeutic Uses


  • Fig. 1. Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) flow diagram outlining the study design. EES, endoscopic ear surgery; MES, microscopic ear surgery.

  • Fig. 2. (A) Forest plot comparing graft success rate between endoscopic ear surgery (experimental) and microscopic ear surgery (control) by using OR. Events represent the number of cases with graft success. (B) Publication bias of graft success rate. OR, odds ratio; CI, confidence interval.

  • Fig. 3. (A) Forest plot comparing the improvement of air-bone gaps of endoscopic ear surgery (experimental) and microscopic ear surgery (control) by using mean difference. (B) Publication bias of hearing outcomes. (C) Adjusted publication bias after trim-and-fill method. SD, standard deviation; MD, median; CI, confidence interval.

  • Fig. 4. (A) Forest plot comparing the canalplasty rate of endoscopic ear surgery (experimental) and microscopic ear surgery (control) by using OR. Events represent the number of cases with canalplasty. (B) Publication bias of canalplasty rate. OR, odds ratio; CI, confidence interval.

  • Fig. 5. (A) Forest plot comparing the operation time of endoscopic ear surgery (experimental) and microscopic ear surgery (control) by using mean difference. (B) Publication bias of operation time. SD, standard deviation; MD, median; CI, confidence interval.

  • Fig. 6. (A) Forest plot comparing the cosmetic results of endoscopic ear surgery (EES; experimental) and microscopic ear surgery (MES; control) by using OR. Events represent the number of cases with cosmetic dissatisfaction. (B) Forest plot comparing the postoperative complications of EES and MES by using OR, with regard to wound problem, epithelial cyst, and wet ear. Events represent the number of cases with each complication. OR, odds ratio; CI, confidence interval.

Cited by  3 articles

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Variations of the Technique in Endoscopic Tympanoplasty
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Korean J Otorhinolaryngol-Head Neck Surg. 2021;64(8):604-606.    doi: 10.3342/kjorl-hns.2021.00493.

Endoscopic Ear Surgery: Paradigm Shift or Subordinate Role?
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Clin Exp Otorhinolaryngol. 2019;12(2):103-104.    doi: 10.21053/ceo.2019.00220.


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