DISCUSSION
In this study, we compared the outcomes of endoscopic with microscopic type I tympanoplasty through a systematic review meta-analysis. Hearing improvement and graft uptake rate of ET were comparable to those of MT. On the other hand, ET was superior to MT in terms of operative time, complications, and the requirement of additional maneuvers.
For decades, Microscope-assisted surgery was the main modality for ear surgery, allowing two-handed manipulation, binocular vision and an excellent stereoscopic surgical view. However, the vision of a microscope is along a straight line and may be limited in hidden areas and the deep recesses of the middle ear, so the surgeon has to use the post-auricular approach instead of the transcanal approach to obtain a wider surgical view.
Endoscope-assisted surgery provides a wide field of view with magnified images, uses a smaller surgical incision, and preserves more tissue. In addition, endoscopes with different angles enable “around the corner” visualization of hidden areas and middle ear recesses. However, the endoscope lacks binocular vision (i.e. lost depth perception) and requires training besides being a one-handed technique, and therefore it is difficult with limited value in case of excessive bleeding in which the blood soils the tip of the endoscope obscuring the surgical field. Moreover, neck strain and backache related to direct vision through the endoscope and arm fatigue due to the weight of the scope and its camera may be demerits that can be overcome with developing a stand for the endoscope.