Abstract：
OBJECTIVE: Endoscopic ear surgery is no longer a promising technique, but a well-established one. This study aims to compare endoscopic and microscopic tympanoplasty based on current literature evidence, in terms of their efficacy and safety characteristics.
METHODS: We conducted a systematic literature search of four medical databases (Pubmed, Cochrane Library, Scopus, ClinicalTrials.gov), focusing on randomized controlled or observational studies comparing microscopic to endoscopic tympanoplasty.
METHODS: Data related to the efficacy and safety of each technique were extracted. Outcome data were summarized using pooled mean differences or pooled odds ratio along with their 95% confidence intervals. The risk of bias was estimated, by using the ROBINS-I and RoB-II assessment tools, while the overall quality of evidence was evaluated according to the GRADE working group.
RESULTS: Thirty-three studies, with 2646 patients in total, were included in the meta-analysis. Success rate was evaluated by estimating tympanic graft failure (pooled mean difference:-0.23; 95% CI: -0.61, 0.14, I2 = 33.42%), and air-bone gap improvement (pooled mean difference:-0.05; 95% CI:-0.23, 0.13, I2 = 52.69%), resulting in comparable outcomes for the two techniques. A statistically significant difference favoring the endoscopic technique was detected regarding postoperative wound infection (OR: -1.72; 95% CI: -3.39, -0.04, I2 = 0%), dysgeusia (OR: -1.47; 95% CI: -2.47, -0.47, I2 = 0%), otitis externa development (OR: -1.96; 95% CI: -3.23, -0.69, I2 = 0%), auricular numbness (OR: -2.56; 95% CI: -3.93, -1.19, I2 = 0%), as well as surgical duration (OR: -1.86; 95% CI: -2.70, -1.02, I2 = 43.95%), when compared to the postauricular microscopic approach.
CONCLUSIONS: Endoscopic tympanoplasty is an innovative alternative to the microscopic technique, resulting in commensurate outcomes regarding success rate. Furthermore, it offers superior results concerning postoperative complications, while it presents a significant reduction in the duration of surgery, mainly when it is compared to the postauricular microscopic approach.
METHODS: NA Laryngoscope, 134:3466-3476, 2024.
METHODS: We conducted a systematic literature search of four medical databases (Pubmed, Cochrane Library, Scopus, ClinicalTrials.gov), focusing on randomized controlled or observational studies comparing microscopic to endoscopic tympanoplasty.
METHODS: Data related to the efficacy and safety of each technique were extracted. Outcome data were summarized using pooled mean differences or pooled odds ratio along with their 95% confidence intervals. The risk of bias was estimated, by using the ROBINS-I and RoB-II assessment tools, while the overall quality of evidence was evaluated according to the GRADE working group.
RESULTS: Thirty-three studies, with 2646 patients in total, were included in the meta-analysis. Success rate was evaluated by estimating tympanic graft failure (pooled mean difference:-0.23; 95% CI: -0.61, 0.14, I2 = 33.42%), and air-bone gap improvement (pooled mean difference:-0.05; 95% CI:-0.23, 0.13, I2 = 52.69%), resulting in comparable outcomes for the two techniques. A statistically significant difference favoring the endoscopic technique was detected regarding postoperative wound infection (OR: -1.72; 95% CI: -3.39, -0.04, I2 = 0%), dysgeusia (OR: -1.47; 95% CI: -2.47, -0.47, I2 = 0%), otitis externa development (OR: -1.96; 95% CI: -3.23, -0.69, I2 = 0%), auricular numbness (OR: -2.56; 95% CI: -3.93, -1.19, I2 = 0%), as well as surgical duration (OR: -1.86; 95% CI: -2.70, -1.02, I2 = 43.95%), when compared to the postauricular microscopic approach.
CONCLUSIONS: Endoscopic tympanoplasty is an innovative alternative to the microscopic technique, resulting in commensurate outcomes regarding success rate. Furthermore, it offers superior results concerning postoperative complications, while it presents a significant reduction in the duration of surgery, mainly when it is compared to the postauricular microscopic approach.
METHODS: NA Laryngoscope, 134:3466-3476, 2024.
摘要：
目的：耳内窥镜手术不再是一种有前途的技术，而是一个成熟的。这项研究旨在比较内镜和显微镜下鼓室成形术基于现有的文献证据，就其功效和安全性而言。
方法：我们对四个医学数据库（Pubmed，科克伦图书馆,Scopus,ClinicalTrials.gov），重点是比较显微镜和内镜鼓室成形术的随机对照或观察性研究。
方法：提取与每种技术的有效性和安全性相关的数据。使用合并均值差异或合并比值比及其95％置信区间对结果数据进行汇总。估计了偏差的风险，通过使用ROBINS-I和RoB-II评估工具，根据GRADE工作组对总体证据质量进行评估。
结果：33项研究，共有2646名患者，纳入荟萃分析。通过估计鼓膜移植物失败来评估成功率（合并平均差：-0.23;95％CI：-0.61，0.14，I2=33.42％），和气隙改善（合并平均差：-0.05；95％CI：-0.23，0.13，I2=52.69％），这两种技术的结果具有可比性。关于术后伤口感染（OR：-1.72;95％CI：-3.39，-0.04，I2=0％），味觉障碍（OR：-1.47；95%CI：-2.47，-0.47，I2=0%），外耳道炎发展(OR:-1.96;95%CI:-3.23,-0.69,I2=0%),耳廓麻木(OR:-2.56;95%CI:-3.93,-1.19,I2=0%),以及手术时间（OR：-1.86；95％CI：-2.70，-1.02，I2=43.95％），与耳后显微镜方法相比。
结论：内窥镜鼓室成形术是显微技术的创新替代方法，导致成功率相应的结果。此外，它提供了关于术后并发症的优越结果，虽然它显著缩短了手术时间，主要是与耳后显微镜方法相比。
方法：NA喉镜，134:3466-3476,2024.
方法：我们对四个医学数据库（Pubmed，科克伦图书馆,Scopus,ClinicalTrials.gov），重点是比较显微镜和内镜鼓室成形术的随机对照或观察性研究。
方法：提取与每种技术的有效性和安全性相关的数据。使用合并均值差异或合并比值比及其95％置信区间对结果数据进行汇总。估计了偏差的风险，通过使用ROBINS-I和RoB-II评估工具，根据GRADE工作组对总体证据质量进行评估。
结果：33项研究，共有2646名患者，纳入荟萃分析。通过估计鼓膜移植物失败来评估成功率（合并平均差：-0.23;95％CI：-0.61，0.14，I2=33.42％），和气隙改善（合并平均差：-0.05；95％CI：-0.23，0.13，I2=52.69％），这两种技术的结果具有可比性。关于术后伤口感染（OR：-1.72;95％CI：-3.39，-0.04，I2=0％），味觉障碍（OR：-1.47；95%CI：-2.47，-0.47，I2=0%），外耳道炎发展(OR:-1.96;95%CI:-3.23,-0.69,I2=0%),耳廓麻木(OR:-2.56;95%CI:-3.93,-1.19,I2=0%),以及手术时间（OR：-1.86；95％CI：-2.70，-1.02，I2=43.95％），与耳后显微镜方法相比。
结论：内窥镜鼓室成形术是显微技术的创新替代方法，导致成功率相应的结果。此外，它提供了关于术后并发症的优越结果，虽然它显著缩短了手术时间，主要是与耳后显微镜方法相比。
方法：NA喉镜，134:3466-3476,2024.
