Department of Otolaryngology-Head and Neck Surgery, University Hospital Galway, Galway, Ireland.
School of Medicine, National University of Ireland Galway, Galway, Ireland.
Laryngoscope. 2023 Jul;133(7):1550-1557. doi: 10.1002/lary.30479. Epub 2022 Nov 9.
Totally endoscopic ear surgery is becoming increasingly utilized in otologic practice. Although the well-established microscope-assisted tympanoplasty remains the most common technique to repair a tympanic membrane defect, the merits of endoscopic approaches have been well-documented. This systematic review and meta-analysis compares the outcomes of endoscopic to microscopic tympanoplasty incorporating only randomized trials.
Systematic review and meta-analysis.
A comprehensive search of PubMed/MEDLINE, Scopus, Cochrane Library, and EMBASE was conducted. All randomized studies comparing endoscopic to microscopic tympanoplasty were collected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Quality assessment was carried out utilizing the Risk of Bias 2.
The initial search identified 1711 studies, of which 9 met the inclusion criteria comprising of 540 patients (microscopic tympanoplasty 51.5%; endoscopic tympanoplasty 49.5%). The mean age was 32.5 years with a similar number of males (50.1%) and females (49.9%). Both endoscopic and microscopic groups had comparable outcomes with regards to graft success rate (RD 0.00; 95% confidence interval [CI], -0.04 to. 0.05; p = 0.87) and hearing improvement (MD 0.57 dB; 95% CI, -1.23 to 2.36; p = 0.54). A significantly shorter operative time was noted in the endoscopic group (MD, -24.73 min; 95% CI, -38.56 to -10.89; p = 0.0005).
Our results, assimilating level 1 evidence, demonstrates that endoscopic and microscopic-assisted type-1 tympanoplasty have similar outcomes in both graft success and hearing improvement, with endoscopic approaches yielding a shorter operative time.
1 Laryngoscope, 133:1550-1557, 2023.
全内镜耳科手术在耳科学领域的应用日益广泛。虽然经显微镜辅助的鼓室成形术仍然是修复鼓膜穿孔的最常用技术，但内镜方法的优点已得到充分证实。本系统评价和荟萃分析比较了仅纳入随机试验的内镜与显微镜下鼓室成形术的结果。
系统评价和荟萃分析。
对 PubMed/MEDLINE、Scopus、Cochrane 图书馆和 EMBASE 进行了全面检索。根据系统评价和荟萃分析的首选报告项目，收集了所有比较内镜与显微镜下鼓室成形术的随机研究。利用偏倚风险 2 进行质量评估。
最初的搜索确定了 1711 项研究，其中 9 项符合纳入标准，包括 540 名患者（显微镜下鼓室成形术 51.5%；内镜下鼓室成形术 49.5%）。平均年龄为 32.5 岁，男性和女性的数量相似（分别为 50.1%和 49.9%）。内镜组和显微镜组在移植物成功率（RD 0.00；95%置信区间 [CI]，-0.04 至.0.05；p=0.87）和听力改善（MD 0.57 dB；95% CI，-1.23 至 2.36；p=0.54）方面均具有可比性。内镜组的手术时间明显缩短（MD，-24.73 分钟；95% CI，-38.56 至-10.89；p=0.0005）。
我们的结果，综合了 1 级证据，表明内镜和显微镜辅助的 1 型鼓室成形术在移植物成功率和听力改善方面具有相似的结果，而内镜方法的手术时间更短。
1 级 Laryngoscope, 133:1550-1557, 2023.
