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.