Endoscopic versus microscopic stapes surgery

Sürmelioğlu, Özgür; Özdemir, Süleyman; Tarkan, Özgür; Tuncer, Ülkü; Dagkiran, Muhammed; Çetik, Fikret

doi:10.1016/j.anl.2016.07.001

Cited by 45 publications

(64 citation statements)

References 19 publications

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“…Likewise, in a recent retrospective study by Surmelioglu et al on 36 patients who had undergone endoscopic and microscopic stapedotomy, Teflon piston was used and a small piece of Gelfoam placed as a sealing material. They also yielded a good hearing outcome without any complication …”

Section: Discussionmentioning

confidence: 91%

Comparing Gelfoam vs fat as a sealing material in stapedotomy: A prospective double‐blind randomised clinical trial

Faramarzi

Roosta

Aminpour

2019

Clinical Otolaryngology

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Objectives One research aspect of stapes surgery is various materials that are used to seal the oval window. Several materials are used to seal the oval window, for example adipose tissue, perichondrium, vein graft, gelatin sponge (Gelfoam), blood clot and soft connective tissue. Up to now, there has been no randomised clinical trial that has evaluated the effects of different types of sealing material on hearing outcomes after stapedotomy. Hence, the present study aimed to find out which of these materials; fat or Gelfoam was associated with better hearing outcome, when used as a sealing material. Design This prospective, double‐blind, randomised clinical trial was carried out on ears that had undergone stapedotomy. Setting Dastgheib Hospital affiliated to Shiraz University of Medical Sciences, a referral otology centre in southern Iran. Participants A total of 176 primary stapedotomies were analysed. Fat harvested from the ear lobule was used in 86 ears and Gelfoam in 90 ears. Main outcome measures Preoperative and postoperative pure tone audiometric data and incidence of sensorineural hearing loss were evaluated. Results Total of 90.7% of all ears in the fat group and 87.8% of ears in Gelfoam group achieved postoperative air‐bone gap (ABG) within 20 dB, and this difference was not significant. There was no case of sensorineural hearing loss (defined as 10 dB or more reduction in BC threshold) in both groups in mean frequencies of 0.5‐3 kHz. There were 9 cases of sensorineural hearing loss at 4 kHz in the fat group vs 4 in the Gelfoam group. The occurrence of sensorineural hearing loss in different frequencies was not significant between the two groups (P > 0.05). In addition, there was no case of dead ear in either group. Conclusions We found similarity between hearing outcome in the Gelfoam and fat as sealing materials in stapedotomy. We believe that the first limitation of this study was the short‐term follow‐up in stapedotomy. The other issue is that one has to be cautious when using our result, which might not be applicable in larger fenestra stapedectomy.

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Section: Discussionmentioning

confidence: 91%

Comparing Gelfoam vs fat as a sealing material in stapedotomy: A prospective double‐blind randomised clinical trial

Faramarzi

Roosta

Aminpour

2019

Clinical Otolaryngology

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“…To the best of our knowledge, few studies have analyzed the advantages for the visualization of middle ear structures during stapes surgery and how this advantage could be of help in stapes surgery [5,6,20] .…”

Section: Discussionmentioning

confidence: 99%

“…First, the monitor can be viewed by both the surgeon and his assistants, making surgical anatomy and procedures more easily understood by trainee surgeons. Second, the endoscope located near to the middle ear structures allows a greater magnification without loss of resolution [7,9,17,18,20,36] . This could be an important advantage to assistants in training who are inexperienced in recognition of middle ear structures.…”

Section: Discussionmentioning

confidence: 99%

“…According to these data, a "total" identification of the stapes footplate and the oval window was 16 J Int Adv Otol 2017; 13(1): [14][15][16][17][18][19][20] Significant information marked in bold. p value has been calculated between "total" identification and overall "partial" and "no" identification of the two different surgical approaches.…”

Section: Understanding Of Middle Ear Anatomy and Surgical Steps Of Stmentioning

confidence: 99%

“…Accordingly, an increasing number of ear-surgeons nowadays considers otosclerosis to be a suitable disease for endoscopic stapes surgery due to the fact that the endoscopic approach offers excellent visualization of middle ear structures and recesses, mainly the oval window niche, stapes anterior crus, and its suprastructure [5,6,[17][18][19] . However, few comparative studies between endoscope and microscope regarding visualization and resolution of middle ear structures in stapes surgery have been reported [5,6,20] .…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic vs Microscopic Approach in Stapes Surgery: Advantages in the Middle Ear Structures Visualization and Trainee's Point of View

Iannella

Marcotullio²,

Re³

et al. 2017

Int Adv Otol

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OBJECTIVE:Comparing the endoscopic and microscopic approaches in stapes surgery, and establishing the surgical approach that allows better results in terms of visualization of the middle ear structures and aids assistant's training. MATERIALS and METHODS:Twenty-one residents from the first to the fifth year of training in Otolaryngology were enrolled in this prospective study. A questionnaire specifically designed to investigate the understanding of middle ear anatomy, the surgical steps, and a personal opinion about endoscopic stapes surgery was submitted to each resident. RESULTS:Statistical differences between the endoscopic and microscopic approaches were evident about identification of stapes and long process of the incus (p=0.03) and stapes footplate and the oval window (p=0.03). No substantial difference between the two surgical approaches emerged regarding the visualization of the tympanic membrane and the other middle ear structures (p>0.5). A substantial difference in favor of the endoscopic approach emerged regarding the identification of the hole creation in the footplate of the stapes. CONCLUSION:Endoscopic stapes surgery could favor an easier understanding of the surgical technique for assistants in training with little knowledge of the anatomy and surgical steps.

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Endoscopic versus microscopic stapes surgery outcomes: A meta‐analysis and systematic review

et al. 2019

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Objective Compare intraoperative and postoperative outcomes of endoscopic and microscopic stapes surgery to provide objective evidence on whether the former is a better alternative than the latter. Methods We performed a systematic review and meta‐analysis for studies that compared endoscopic stapes surgery with microscopic stapes surgery. Only studies that met predetermined criteria were selected and assessed for bias and quality. Primary outcomes were postoperative air–bone gap (ABG) and chorda tympani nerve injury. Secondary outcomes were average operating time, tympanic membrane (TM) perforation, and postoperative taste disturbance, pain, and dizziness. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous outcomes and weighted mean difference (WMD) with 95% CI for continuous outcomes. A confidence interval starting above 1.0 was considered as statistically significant. I2 and χ2 tests were used to quantify statistical heterogeneity. We used funnel plots to look for publication bias and performed a sensitivity analysis. Results Six nonrandomized cohort studies were eligible. The primary outcomes were ABG < 10 dB: OR = 1.80 (95% CI: 0.96 to 3.38), ABG = 11 dB to 20 dB: OR = 1.49 (95% CI: 0.76 to 2.93), ABG > 20 dB: OR = 2.51 (95% CI: 0.77 to 8.22), and chorda tympani injury: OR = 3.51 (95% CI: 1.55 to 7.93). Secondary outcomes were taste: OR = 2.36 (95% CI: 1.01 to 5.51), average operation time: WMD = 0.14 (95% CI: −11.69 to 11.98), TM perforation: OR = 1.70 (95% CI: 0.44 to 6.58); pain: OR = 0.84 (95% CI: 0.36 to 1.96), and dizziness: OR = 2.15 (95% CI: 0.94 to 4.89). Conclusions Endoscopic stapes surgery is a valid alternative to the microscope. Level of Evidence 2a Laryngoscope, 130: 2019–2027, 2020

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Endoscopic versus microscopic stapes surgery

Cited by 45 publications

References 19 publications

Comparing Gelfoam vs fat as a sealing material in stapedotomy: A prospective double‐blind randomised clinical trial

Comparing Gelfoam vs fat as a sealing material in stapedotomy: A prospective double‐blind randomised clinical trial

Endoscopic vs Microscopic Approach in Stapes Surgery: Advantages in the Middle Ear Structures Visualization and Trainee's Point of View

Endoscopic versus microscopic stapes surgery outcomes: A meta‐analysis and systematic review

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