Comparative Outcomes of Endoscopic and Microscopic Tympanoplasty: A Systematic Review and Meta-Analysis

Background: Tympanoplasty is a commonly performed procedure for the repair of tympanic membrane perforations and restoration of hearing. While microscopic tympanoplasty (MT) has long been the standard approach, endoscopic tympanoplasty (ET) has emerged as a minimally invasive alternative with improved visualization and potential clinical advantages.

Objective: To systematically compare the outcomes of endoscopic and microscopic tympanoplasty in terms of graft success rate, hearing improvement, operative time, postoperative complications, and cosmetic outcomes.

Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Electronic databases including PubMed, Scopus, Embase, and Cochrane Library were searched for studies published between 2000 and 2025. Randomized controlled trials and comparative observational studies evaluating ET versus MT in Type I tympanoplasty were included. Data extraction and quality assessment were performed independently by two reviewers. Meta-analysis was conducted using a random-effects model, and outcomes were expressed as odds ratios (OR) or mean differences (MD) with 95% confidence intervals.

Results: A total of 33 studies comprising 2,646 patients (1,318 ET; 1,328 MT) were included. The pooled graft success rate was comparable between ET (94.2%) and MT (93.5%) (OR 1.08; 95% CI 0.85–1.36; p = 0.52). Hearing improvement, measured by air-bone gap closure, showed no significant difference (MD 0.18 dB; 95% CI −0.27 to 0.63; p = 0.43). ET demonstrated a significantly shorter operative time (MD −18.6 minutes; p < 0.001) and lower postoperative complication rates (6.8% vs 11.2%; OR 0.56; p = 0.002). Cosmetic outcomes were consistently superior in the ET group.

Conclusion: Endoscopic tympanoplasty is comparable to microscopic tympanoplasty in terms of graft success and hearing outcomes, while offering significant advantages in operative efficiency, reduced morbidity, and improved cosmesis. ET represents a safe and effective minimally invasive alternative and may be considered the preferred approach in appropriately selected patients.