A comparative study of endoscopic assisted versus conventional middle ear and mastoid surgery at a tertiary care teaching hospital

Abstract

<p><strong>Background:</strong> Objectives were to compare outcomes, intra operative visualization and operative time duration in endoscopic assisted vs conventional middle ear and mastoid surgery.</p><p><strong>Methods: </strong>This prospective comparative study was conducted in 50 patients; among them 25 cases were of endoscope assisted middle ear surgery and 25 cases with conventional microscopic middle ear surgery. A 4 mm diameter, 18 cm long rigid, zero-degree endoscope and operating microscope was used. Primary outcomes include mean average pre and post operative air-bone (A-B) gap, hearing thresholds, intra operative visualization and duration of surgery.<strong></strong></p><p><strong>Results: </strong>Mean A-B gap closure for endoscopic assisted tympanoplasty was 12.76±6.00 dB, while it was 8.38±5.78 dB for non-endoscopic assisted tympanoplasty. The results were comparative. Mean intra-operative time duration for endoscopic assisted tympanoplasty was 70.23±4.17 min, while it was 77±9.80 min for non-endoscopic assisted tympanoplasty with statically significant difference between both groups (p=0.03). Graft uptake rate for endoscopic assisted tympanoplasty was 92.31% while it was 84.62% for non-endoscopic assisted tympanoplasty. Residual cholesteatoma remnant on endoscopy was found in 43.66% cases out of 12 mastoidectomy cases performed via endoscopic assistance.<strong></strong></p><p><strong>Conclusions: </strong>The endoscope can be successfully applied to ear surgery for most of the ear procedures with a reasonable success rate both in terms of perforation closure and hearing improvement and with minimal exposure. Wide-field zero, 30 or 70° endoscope sallow visualization of hidden anatomic spaces and working around corners i.e., epitympanum, hypotympanum and retro tympanum for safe removal of cholesteatoma.</p>