INTRODUCTION
Tympanoplasty is a surgical procedure aiming at eradication of infection, repair of the perforated tympanic membrane (TM), and hearing rehabilitation in patients with chronic otitis media (COM).1 Middle ear infections, trauma or iatrogenic injury are the principal causes of the TM perforation. Up to 80% of TM perforations heal spontaneously;2 as for the remaining, surgical repair is usually required.3
With the endoscope assistance, minimally invasive techniques of ear surgery have arisen and evolved since the 1990s.4Analogous to functional endoscopic sinus surgery, so too did the concept of functional endoscopic ear surgery (FEES). The philosophy of FEES fundamentally supports three essential principles: 1. using the external auditory canal (EAC) as the natural conduit to the tympanic cavity; 2. restoring normal ventilation routes of the middle ear and the mastoid; and 3. conserving as much normal anatomy as possible.5 Consequently, endoscopic ear surgery has become widely accepted with anatomical and physiological concepts.6
Despite the well-known merits of endoscopic techniques, some concerns about their efficiency and safety are still exist among some ear surgeons and hinder the transition from conventional microscopic tympanoplasty to endoscopic tympanoplasty for those surgeons.7
Therefore, there is a need for a meta-analysis comparing the outcomes of both endoscopy and microscopy techniques of type I tympanoplasty in terms of efficacy and safety.