Endoscopic ossiculoplasty: Is there any edge over the microscopic technique?

Abstract

Objectives/Hypothesis To compare endoscopic ossiculoplasty with conventional microscopic technique in terms of postoperative hearing outcomes and complications. Study Design Randomized controlled trial. Methods One hundred eighteen patients diagnosed with ossicular chain discontinuity were randomly assigned into two groups, one undergoing endoscopic ossiculoplasty and the other undergoing ossiculoplasty by the microscopic technique, with the operating surgeon being same for both groups. The two groups were compared in terms of operative time, postoperative air‐bone gap, mean air‐bone gap closure, and incidence of complications. Teflon prostheses (partial ossicular chain replacement prosthesis [PORP] and total ossicular chain replacement prosthesis [TORP]) were used for reconstruction in all cases. Results Endoscopic ossiculoplasty with PORP rendered a statistically significant mean postoperative air‐bone gap and air‐bone gap closure at 1 month when compared to that of microscopic PORP ossiculoplasty. However, there was no significant difference between the two techniques in terms of mean postoperative air‐bone gap and air‐bone gap closure at 3 and 6 months. In the TORP ossiculoplasty cases, there was no significant difference in mean postoperative air‐bone gap and air‐bone gap closure at 1, 3, and 6 months. In terms of operative time and incidence of complications, no statistical significance was found between the two groups. Conclusions Endoscopic ossiculoplasty appears to provide superior visualization and better early audiological outcome (in PORP ossiculoplasty cases) when compared to microscopic technique. However, long‐term audiological outcomes and incidence of complications remain comparable. Level of Evidence 1 Laryngoscope, 130:797–802, 2020

Comparison of Long-Term Microscopic and Endoscopic Audiologic Results After Total Ossicular Replacement Prosthesis Surgery

“…To our knowledge, our study is the largest to primarily investigate the results of endoscope-assisted total ossiculoplasty. In addition, our follow-up is longer than previously described in literature (1–3). Das et al (1) described significantly better hearing results 1 month after endoscope-assisted ossiculoplasty in comparison to microscope-assisted ossiculoplasty.…”

“…Despite the frequent use of endoscopes in ear surgery, only three studies with a small number of endoscopically treated patients (n < 21) with a follow-up of less than 6 months have evaluated the endoscope's role in total ossiculoplasty. Das et al ( 1 ) described significantly better hearing results 1 month after endoscope-assisted ossiculoplasty in comparison to microscope-assisted ossiculoplasty. At 6 months after surgery both methods were shown to have comparable audiologic outcomes (endoscopic group: n = 14, follow-up 6 months, postoperative air bone gap (ABG) PTA 0.5-3kHz 26.2 dB).…”

Audiometric Outcomes Comparing Endoscopic Versus Microscopic Ossiculoplasty

“…Previous studies (41)(42)(43)(44)(45)(46) have found TEES ossiculoplasty to be at least equivalent to the microscopic approach. We hypothesized that TEES ossiculoplasty would result in a similar audiometric outcomes compared with microscopic ossiculoplasty based on the literature.…”

Comparing Transcanal Endoscopic Ear Surgery to Post-Auricular Microscope-Guided Surgery in Pediatric Ossiculoplasty: Hearing Outcomes and Post-Operative Pain

“…Previous studies have shown equivalent or improved results from endoscopic versus microscope-guided tympanic membrane perforation closure and clearance of cholesteatoma in children (8,9). Research suggests that audiometric outcomes are equivalent in experienced hands between TEES and PAM approaches for most common procedures including tympanoplasty, ossiculoplasty, and stapedotomy (3,7,8,(10)(11)(12)(13). Because TEES allows surgeons to complete these procedures with less soft tissue dissection than by a post-auricular approach, examination of secondary patient outcomes related to surgical morbidity may demonstrate a potential benefit of TEES over post-auricular surgery.…”