Comparison of endoscopic and microscopic ear surgery in pediatric patients: A meta‐analysis

Abstract

Objectives Recently, the endoscope has been increasingly introduced for middle‐ear surgery. To evaluate the postoperative outcomes of endoscopic ear surgery (EES) in pediatric patients, we did a qualitative analysis with a systematic review and quantitative analysis with meta‐analysis of available literature. Methods Studies reporting the comparative surgical outcomes of EES in pediatric patients were systematically reviewed by searching the MEDLINE, PubMed, and Embase databases from database inception through 2017. The selected articles included clinical studies conducted with at least 30 subjects and at least one postoperative parameter, including residual or recurrent cholesteatoma and graft success in tympanoplasty. Two investigators independently reviewed all studies and extracted the data using a standardized form. A meta‐analysis was performed using a random‐effects model and qualitative review was performed on the smaller studies. Results Ten studies were identified as appropriate for quantitative meta‐analysis and 19 studies for qualitative analysis. In the meta‐analysis, residual or recurrence rate of cholesteatoma was significantly lower in the EES group than in the microscopic ear surgery (MES) group (odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.38‐0.84, P = .005). The graft success rate of tympanoplasty was not statistically different between EES and MES groups (OR: 0.72, 95% CI: 0.41‐1.26, P = .249). In the qualitative analysis, most of the studies reported similar audiological outcomes after tympanoplasty and success rate of cholesteatoma removal between the two groups. Conclusions It appears that EES reduces the risk of residual cholesteatoma in children and that the success of perforation closure is equivalent to MES. Laryngoscope, 129:1444–1452, 2019

Heads-up Surgery

“…TEES diminishes the need for a canal wall up mastoidectomy in some cases 12 and facilitates en bloc removal of cholesteatoma, with an improved chance of ossicular preservation 13 and decreased rates of residual and recurrent disease. 14 In studies comparing TEES to microscopic surgery for cholesteatoma, results have shown comparable or improved rates of control, 15 improved quality of life, decreased surgical morbidity, shorter healing time, and less postoperative pain due to avoidance of postauricular incisions. 16 TEES for tympanoplasty results in similar outcomes compared to microscopic approaches.…”

Does microscopic experience influence learning curve in endoscopic ear surgery? A multicentric study

“…Many papers have described so far the outcomes and the benefits of endoscopic ear surgery, particularly with respect to tympanoplasty [1 , 6 , 12 , 13] , as well as many have performed a comparison between endoscopy and microscopy [14][15][16] . However, few studies explored the learning curve in endoscopic ear surgery [8][9][10] and none has focused on what is like for a surgeon already trained in microscopy to deal with the endoscopic learning curve and what are the main difficulties compared to a neophyte surgeon.…”

Endoscopic Removal of Medially Migrated Tympanostomy Tube

“…3,4 The authors who compared EES to microscopic ear surgery (MES) in myringotomy or myringoplasty as well as placing tympanostomy tubes reported results which are comparable if not better than MES. 5,6 Endoscopic technique was also reported very effective in other procedures, such as ossiculoplasty, stapedotomy, or cholesteatoma surgery, allowing visualization of the middle ear structures from angles which couldn't be possible with MES, therefore lowering the recurrence rate. Endoscopic ear surgery can be a valuable tool in education, allowing demonstration of surgical steps and anatomical relationships of tympanic membrane and middle ear.…”