Systematic Review of Endoscopic Myringoplasty and Comparison with Microscopic Myringoplasty with Meta-Analysis

By June 7, 2019

Wong, Eugene1; Lui, Rodney2; Kong, Jonathan3,4; Jufas, Nicholas3,5; Patel, Nirmal3,5; Saxby, Alex3,4
1 Department of Otolaryngology – Head and Neck Surgery, Westmead Hospital, Westmead NSW, Australia;
2 Department of Otolaryngology – Head and Neck Surgery, Northern Beaches Hospital, Frenchs Forest NSW, Australia;
3 Sydney Endoscopic Ear Surgery Research Group, Australia;
4 Department of Otolaryngology – Head and Neck Surgery, Royal Prince Alfred Hospital, Camperdown NSW, Australia;
5 Department of Otolaryngology – Head and Neck Surgery, Royal North Shore Hospital, Crows Nest NSW, Australia.

Several methods of myringoplasty have been utilised over the years. Traditionally, myringoplasty was typically performed using the operating microscope. However, the use of the endoscope confers a number of potential benefits, including greater clarity of image, a wider panoramic operative view, and the potential use of angled scopes to view “around” obstructing anatomy. On the other hand, the microscope produces three dimensional images and allows the surgeon to use both hands while operating. Therefore, a systematic review was performed to determine the efficacy of endoscopic myringoplasty in the published literature, and to perform a meta-analysis of those studies who compared outcomes with traditional microscopic surgery.

Electronic searches were performed using ten electronic databases (including Medline; EMBASE; Premedline) from their inception to February 2019. All observational studies (of any language) reporting data on endoscopic myringoplasty were retrieved, unless ossicular chain reconstruction was concurrently performed, surgical indication included middle ear pathology other than CSOM, revision procedure or if patients had less than 3 months follow-up.

The primary outcomes assessed were early and late graft reuptake rate. Secondary outcomes, where reported, included audiometric improvement, rate of canalplasty, operative time, hospital length of stay and time to return to work, cosmetic outcome, post-operative pain and complication profile.

Data Extraction:
Systematic review was performed as per PRISMA guidelines.

Data Synthesis:
Where studies reported comparison microscopic data in the same paper, meta-analysis was performed using a random effects model with odds ratio as the effect size and heterogeneity determined using I2 analysis.

Full results will be disseminated at time of conference.