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Endoscopic Versus Microscopic Stapedotomy: A Single-Blinded Randomized Control Trial.

Caleb J Fan1, Vivian F Kaul, Maria A Mavrommatis

  • 1Department of Otolaryngology-Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.

Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [And] European Academy of Otology and Neurotology
|November 2, 2021
PubMed
Summary

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Endoscopic stapedotomy is as effective as microscopic stapedotomy for treating otosclerosis, showing non-inferiority in hearing outcomes. This study confirms endoscopic approach safety and efficacy in a randomized trial.

Area of Science:

  • Otolaryngology
  • Neurosurgery
  • Audiology

Background:

  • Otosclerosis, a condition causing hearing loss, is often treated with stapedotomy.
  • Microscopic stapedotomy is the traditional surgical approach.
  • Endoscopic stapedotomy offers a potential alternative with minimally invasive benefits.

Purpose of the Study:

  • To demonstrate the non-inferiority of endoscopic stapedotomy compared to microscopic stapedotomy for otosclerosis treatment.
  • To evaluate audiometric outcomes and safety profiles of both surgical techniques.

Main Methods:

  • A single-blinded randomized controlled trial was conducted in a tertiary academic otology-neurotology practice.
  • Adult patients with otosclerosis and a preoperative air-bone gap (ABG) of at least 20 dB underwent primary stapedotomy.

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  • Interventions included either endoscopic or microscopic stapedotomy, with ABG as the primary outcome measure.

    • Main Results:

    • The endoscopic group was found to be non-inferior to the microscopic group across key audiometric outcomes, including postoperative ABG, speech reception threshold (SRT), and word recognition score (WRS).
    • ABG closure rates to ≤10 dB and ≤20 dB were not significantly different between the groups.
    • No significant differences were observed in operative time, need for scutum curettage, or postoperative dysgeusia.

    Conclusions:

    • This study is the first randomized controlled trial to establish the non-inferiority of endoscopic stapedotomy to microscopic stapedotomy.
    • Endoscopic stapedotomy is a safe and effective alternative for treating otosclerosis, yielding comparable hearing results to the microscopic approach.