Stapedotomy using a 4 mm endoscope: any advantage over a microscope?

Abstract

ObjectivesTo ascertain the feasibility of endoscopic (4 mm) stapedotomy, and compare intra- and post-operative variations with microscopic stapedotomies.MethodsForty otosclerosis patients were scheduled for microscopic or endoscopic stapedotomy. Intra-operative variables compared were: incision, canalplasty, canal wall curettage for ossicular assessment, chorda tympani manipulation, ability to perform stapes footplate perforation before its supra-structure removal, and operative time. Post-operative variables compared were ear pain and hearing improvement.ResultsOf the 20 microscopy patients, 4 required endaural incision and canalplasty because of canal overhangs, and 7 required canal wall curettage for ossicular assessment. None of the 20 endoscopy patients required these procedures. Chorda tympani was manipulated in 13 and 6 patients in the microscopy and endoscopy groups respectively, while the stapes footplate could be perforated in 5 and 11 patients respectively. Mean operative time was 50.25 and 76.05 minutes in the microscopy and endoscopy groups respectively. In the endoscopy group, mean air–bone gap was 37.12 and 10.73 dB pre- and post-operation respectively; in the microscopy group, these values were 35.95 and 13.81 dB.ConclusionEndoscopic stapedotomy has comparable hearing outcomes. Sinonasal endoscope serves as a better tool for: minimal incision, canalplasty avoidance, less chorda tympani mobilisation, and stapes footplate perforation ability.

Microscopic versus endoscopic stapes surgery: systematic review and meta-analysis

“…32,33 Nevertheless, like any other newly introduced technology, this innovative approach has a learning curve for every surgeon not acquainted with endoscopic otology. 16,[18][19][20]23,34 In line with this view, Iannella and Magliulo reported that operative duration seemed to decrease with greater experience. 15 The Journal of Laryngology & Otology However, as the microscopic technique is of great importance and cannot be entirely substituted, ENT trainees should be enrolled in augmented learning curricula, combining microscopic and endoscopic ear surgery teaching, allowing optimal performance in otological surgery.…”

“…Based on five studies, 13,16–18,20 the pooled air–bone gap after endoscopic and microscopic stapes surgery was 9.08 dB (95 per cent CI = 7.06, 11.10) and 10.79 dB (95 per cent CI = 7.82, 13.75), respectively. In the absence of statistical heterogeneity ( I 2 = 51.57 per cent, p Q = 0.08), there was no difference in terms of success rate between the two treatments (pooled mean difference = −0.20; 95 per cent CI = −0.53, 0.14) (Figure 2).…”

“…Quantitative characteristics for these nine studies are presented in Table 2. [12][13][14][15][16][17][18][19][20] The selected articles included a total of 705 patients (711 ears) who underwent endoscopic or microscopic stapes surgery. All articles were written in English language, and were published between 2014 and 2021.…”

“…With regard to the randomised, controlled study, a 'low' risk of bias was ascertained in all domains. Evaluation findings for the observational studies [12][13][14][15][16][17][18][19][21][22][23][24] are presented in Table 5, and those for the randomised, controlled trial 20 are shown in Table 6. The overall quality of evidence was found to be 'very low' for three outcomes evaluated (pain, dysgeusia and dizziness) and 'low' for one outcome (success rate).…”

“…Based on five studies, 13,[16][17][18]20 the pooled air-bone gap after endoscopic and microscopic stapes surgery was 9.08 dB 2). In addition, the regression test for funnel plot asymmetry failed to detect publication bias ( p = 9.79).…”