Endoscopic stapedotomy: Merits and demerits.

Area of Science:

• Otolaryngology
• Surgical Innovation
• Auditory Medicine

Background:

• Surgical microscopes are standard for stapes surgery, but endoscopes offer potential advantages like enhanced visualization of the oval window niche, stapes, and facial nerve.
• Endoscopic approaches may improve surgical accessibility and provide a panoramic view during stapes procedures.

Purpose of the Study:

• To compare the outcomes and complications of endoscopic versus microscopic stapes surgery.
• To evaluate the audiological results and surgical feasibility of using endoscopes in stapes procedures.

Main Methods:

• A comparative study was conducted between September 2015 and July 2016 at Mansoura University, Egypt.
• Patients diagnosed with otosclerosis were randomly assigned to either a microscopic (Group A, 28 patients) or endoscopic (Group B, 14 patients) stapes surgery group.
• Follow-up durations averaged 4.5 months for the endoscopic group and 5.5 months for the microscopic group.

Main Results:

• A statistically significant difference was observed in the preoperative and postoperative air-bone gap between the two groups (p = 0.031).
• However, no significant difference in overall hearing results was found, indicating similar audiological outcomes for both endoscopic and microscopic techniques.
• Endoscopic stapedotomy demonstrated benefits including high-quality panoramic imaging, clear visualization of middle ear structures, and minimal manipulation of the chorda tympani nerve.

Conclusions:

• Stapes surgery can be successfully performed using 4mm diameter, 18cm long endoscopes with various angulations.
• Endoscopic stapes surgery presents a feasible alternative to microscopic techniques, offering comparable audiological outcomes with potential advantages in visualization and accessibility.