Comparative study between microscopic and endoscopic stapes surgery

Abstract

<p class="abstract"><strong>Background:</strong> To investigate whether endoscopic stapes surgery is safer and less invasive than conventional stapes surgery using an operating microscope.</p><p class="abstract"><strong>Methods:</strong> The subjects were 60 patients who were divided consecutively into group A undergoing microscopic stapedotomy and group B undergoing endoscopic stapedotomy. The procedures for endoscopic surgery were fundamentally the same as those for microscopic surgery, except for post aural incision used in some patients in microscopic group. The two surgical techniques were compared with respect to the operating time, approach, drilling of posterosuperior canal, manipulation of chorda tympani, visualisation of anterior crus, postoperative hearing, postoperative pain, and complications. </p><p class="abstract"><strong>Results:</strong> There were no differences of operating time or postoperative hearing between the endoscopic and microscopic groups. There was very little postoperative pain in the endoscopic group. Drilling at the posterosuperior part of the external auditory canal was less extensive in the endoscopic group than in the microscopic group. Visualisation of anterior crus of stapes was good in endoscopic group.</p><p><strong>Conclusions:</strong> Endoscopic stapes surgeries are technically feasible, safe and promising. The main advantages were: easy access, virtually no trauma to the chorda tympani nerve and excellent vision. The disadvantages were the lack of stereoscopic vision, having to work with one hand only and the learning curve. </p>

Endoscopic Stapedotomy: Overcoming Limitations of Operating Microscope

“…Similar results were found by Hunter and Rivas and Harikumar and Arun Kumar. 15,16 In both the groups, the air-bone gap was closed to <10 dB postoperatively and no significant differences were found in this respect. Similarly, the subjective complaints of dizziness or vertigo as reported postoperatively at the end of the first week were same in both groups.…”

“…In contrary to other studies, in our study, the surgical time taken was longer in microscopic stapedotomy than when performed with endoscopes. 7,14,15 This could possibly be attributed to greater time spent to curette/drill the posterior bony wall and more chorda maneuvering to obtain a clear field of view.…”

“…Similar results were found by Hunter and Rivas and Harikumar and Arun Kumar. 15,16…”

Postoperative Pain After Endoscopic vs Microscopic Otologic Surgery: A Systematic Review and Meta‐analysis

“…TGPS: A categorical pain rating system consisting of “almost no pain,”“mild pain not requiring analgesia,” or “moderate pain requiring analgesic treatment.” Five studies (35.7%) used this scale. 11-15…”

“…11,[13][14][15]17 Eighty percent of studies demonstrated operative time to be shorter or no different in EES. 11,14,15,17 Only 1 study showed a shorter operative time in the MES group but noted that this resolves with mastering of the steep learning curve associated with EES. 13 Transient dysgeusia was significantly lower in the EES group in 2 studies.…”