Objective: to analyze and compare the available data on the outcomes of endoscopic and microscopic type I tympanoplasty. Data Sources: PubMed, Cochrane library Ovid, Scopus, Google scholar, and ClinicalTrials. Review Methods: We conducted a meta-analysis in accordance to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We included comparative studies describing type I tympanoplasty, and comparing surgical outcomes of the endoscope with the microscope in terms of efficacy and safety. Results: Our systematic search yielded 22 studies meeting the inclusion criteria and eligible for analysis. The pooled graft uptake rates and audiological results of endoscopic and microscopic tympanoplasty demonstrated non-significant differences. In contrast, the endoscopic type I tympanoplasty outperforms the microscopic tympanoplasty regarding a highly significant decrease not only in pooled mean operative time, but also in the pooled rates of the additional maneuvers, postoperative pain and complications. Conclusions: Based on our meta-analysis, the surgical outcomes of endoscope-assisted and microscope-assisted type I tympanoplasty in terms of postoperative hearing outcomes and the graft uptake rate were comparable. On the contrary, operative time, additional maneuvers rate, postoperative pain rate and complications rate proved to be significantly reduced with endoscopy compared to microscopy. Hence, the endoscope is as efficient as the microscope in type I tympanoplasty but less invasive, fewer in complications and shorter in operative time.