Abstract：
OBJECTIVE: Our objective was to perform a systematic review and meta-analysis comparing the clinical outcomes after endoscopic and microscopic type I tympanoplasty.
METHODS: Randomized controlled trials, two-arm prospective studies, and retrospective studies were included.
METHODS: Medline, Cochrane, EMBASE, and Google Scholar databases were searched until March 1, 2022 using the combinations of search terms: \"endoscopic,\" \"microscopic,\" and \"tympanoplasty.\"
METHODS: Two independent reviewers utilized the abovementioned search strategy to identify eligible studies. If any uncertainty existed regarding eligibility, a third reviewer was consulted. Primary outcome measures were graft success rate, air-bone gap (ABG) improvement, and operative time. Secondary outcomes were the rate of need for canalplasty, the proportion of self-rated excellent cosmetic results, and pain visual analog scale (VAS).
RESULTS: Forty-three studies enrolled a total of 3712 patients who were undergoing type I tympanoplasty and were finally included. The pooled result showed endoscopic approach was significantly associated with shorter operative time (difference in means: -20.021, 95% confidence interval [CI]: -31.431 to -8.611), less need for canalplasty (odds ratio [OR]: 0.065, 95% CI: 0.026-0.164), more self-rated excellent cosmetic results (OR: 87.323, 95% CI: 26.750-285.063), and lower pain VAS (difference in means: -2.513, 95% CI: -4.737 to -0.228). No significant differences in graft success rate or ABG were observed between the two procedures.
CONCLUSIONS: Endoscopic type I tympanoplasty provides a similar graft success rate, improvement in ABG, and reperforation rate to microscopic tympanoplasty with a shorter operative time, better self-rated cosmetic results, and less pain. Unless contraindicated, the endoscopic approach should be the procedure of choice in type I tympanoplasty.
METHODS: Randomized controlled trials, two-arm prospective studies, and retrospective studies were included.
METHODS: Medline, Cochrane, EMBASE, and Google Scholar databases were searched until March 1, 2022 using the combinations of search terms: \"endoscopic,\" \"microscopic,\" and \"tympanoplasty.\"
METHODS: Two independent reviewers utilized the abovementioned search strategy to identify eligible studies. If any uncertainty existed regarding eligibility, a third reviewer was consulted. Primary outcome measures were graft success rate, air-bone gap (ABG) improvement, and operative time. Secondary outcomes were the rate of need for canalplasty, the proportion of self-rated excellent cosmetic results, and pain visual analog scale (VAS).
RESULTS: Forty-three studies enrolled a total of 3712 patients who were undergoing type I tympanoplasty and were finally included. The pooled result showed endoscopic approach was significantly associated with shorter operative time (difference in means: -20.021, 95% confidence interval [CI]: -31.431 to -8.611), less need for canalplasty (odds ratio [OR]: 0.065, 95% CI: 0.026-0.164), more self-rated excellent cosmetic results (OR: 87.323, 95% CI: 26.750-285.063), and lower pain VAS (difference in means: -2.513, 95% CI: -4.737 to -0.228). No significant differences in graft success rate or ABG were observed between the two procedures.
CONCLUSIONS: Endoscopic type I tympanoplasty provides a similar graft success rate, improvement in ABG, and reperforation rate to microscopic tympanoplasty with a shorter operative time, better self-rated cosmetic results, and less pain. Unless contraindicated, the endoscopic approach should be the procedure of choice in type I tympanoplasty.
摘要：
目的：我们的目的是对内镜和显微镜下的I型鼓室成形术后的临床结果进行系统评价和荟萃分析。
方法：随机对照试验，双臂前瞻性研究，并纳入回顾性研究.
方法：Medline，科克伦,EMBASE,和谷歌学者数据库使用搜索词的组合进行搜索，直到2022年3月1日：“内窥镜，\“\”微观，“和”鼓室成形术。
方法：两名独立的评审员利用上述搜索策略来确定符合条件的研究。如果在资格方面存在任何不确定性，咨询了第三位审稿人。主要结果指标是移植成功率，空气-骨间隙（ABG）的改善，和手术时间。次要结果是泪管成形术的需要率，自评优秀美容效果的比例，疼痛视觉模拟量表(VAS)。
结果：43项研究共纳入了3712例接受I型鼓室成形术的患者，并最终纳入其中。合并结果显示，内镜入路与较短的手术时间显着相关（平均值差异：-20.021，95％置信区间[CI]：-31.431至-8.611），泪管成形术的需要减少(比值比[OR]：0.065，95%CI：0.026-0.164)，更多自我评价的优秀化妆品效果（OR：87.323，95%CI：26.750-285.063），和较低的疼痛VAS（平均值差异：-2.513，95％CI：-4.737至-0.228）。两种手术之间的移植成功率或ABG没有显着差异。
结论：内窥镜I型鼓室成形术提供了相似的移植成功率，ABG的改进，显微鼓室成形术的再穿孔率，手术时间短，更好的自我评价的化妆品效果，更少的痛苦。除非有禁忌,内窥镜入路应该是I型鼓室成形术的首选方法.
方法：随机对照试验，双臂前瞻性研究，并纳入回顾性研究.
方法：Medline，科克伦,EMBASE,和谷歌学者数据库使用搜索词的组合进行搜索，直到2022年3月1日：“内窥镜，\“\”微观，“和”鼓室成形术。
方法：两名独立的评审员利用上述搜索策略来确定符合条件的研究。如果在资格方面存在任何不确定性，咨询了第三位审稿人。主要结果指标是移植成功率，空气-骨间隙（ABG）的改善，和手术时间。次要结果是泪管成形术的需要率，自评优秀美容效果的比例，疼痛视觉模拟量表(VAS)。
结果：43项研究共纳入了3712例接受I型鼓室成形术的患者，并最终纳入其中。合并结果显示，内镜入路与较短的手术时间显着相关（平均值差异：-20.021，95％置信区间[CI]：-31.431至-8.611），泪管成形术的需要减少(比值比[OR]：0.065，95%CI：0.026-0.164)，更多自我评价的优秀化妆品效果（OR：87.323，95%CI：26.750-285.063），和较低的疼痛VAS（平均值差异：-2.513，95％CI：-4.737至-0.228）。两种手术之间的移植成功率或ABG没有显着差异。
结论：内窥镜I型鼓室成形术提供了相似的移植成功率，ABG的改进，显微鼓室成形术的再穿孔率，手术时间短，更好的自我评价的化妆品效果，更少的痛苦。除非有禁忌,内窥镜入路应该是I型鼓室成形术的首选方法.
