Comparative Outcomes of Endoscopic Versus Microscopic Tympanoplasty in Chronic Otitis Media: A systematic review.
Keywords:
Endoscopic tympanoplasty, Microscopic tympanoplasty, Chronic otitis media, Hearing outcome, Graft success rate, Middle ear surgery.Abstract
Background: Chronic otitis media (COM) is a persistent inflammatory condition of the middle ear that frequently leads to tympanic membrane perforation, hearing loss, and recurrent otorrhea. Tympanoplasty remains the standard surgical procedure to restore hearing and the integrity of the tympanic membrane. Traditionally performed using a microscope, the procedure has evolved with the advent of endoscopic ear surgery, offering improved visualization and minimally invasive access. However, evidence comparing the outcomes of endoscopic versus microscopic tympanoplasty remains heterogeneous.
Objective: To systematically review and compare surgical and audiological outcomes of endoscopic and microscopic tympanoplasty in patients with chronic otitis media, focusing on graft success rate, postoperative hearing gain, operative time, complications, and patient recovery.
Methods: Electronic databases including PubMed, Scopus, Web of Science, and Cochrane Library were searched for studies published from 2010 to 2025. Only randomized controlled trials (RCTs), cohort studies, and meta-analyses comparing endoscopic and microscopic tympanoplasty in adults with COM were included. Data regarding graft uptake, hearing improvement (air-bone gap closure), operative duration, postoperative complications, and hospital stay were extracted and analyzed descriptively.
Results: Across the included studies, both approaches achieved comparable graft success rates. Endoscopic tympanoplasty was consistently associated with shorter operative time, reduced postoperative pain, and quicker recovery. Several studies reported equivalent or slightly superior hearing outcomes with the endoscopic technique, particularly for small to medium perforations. Microscopic tympanoplasty remained advantageous in cases requiring extensive canaloplasty or ossiculoplasty.
Conclusion: Both endoscopic and microscopic tympanoplasty are effective in managing chronic otitis media. The endoscopic approach offers a minimally invasive alternative with faster recovery and similar graft success. However, microscopic tympanoplasty remains valuable for complex or revision cases. Larger, standardized RCTs with long-term follow-up are required to establish evidence-based surgical recommendations.
