Endoscopic versus microscopic stapes surgery outcomes: A meta‐analysis and systematic review

Abstract

Objective Compare intraoperative and postoperative outcomes of endoscopic and microscopic stapes surgery to provide objective evidence on whether the former is a better alternative than the latter. Methods We performed a systematic review and meta‐analysis for studies that compared endoscopic stapes surgery with microscopic stapes surgery. Only studies that met predetermined criteria were selected and assessed for bias and quality. Primary outcomes were postoperative air–bone gap (ABG) and chorda tympani nerve injury. Secondary outcomes were average operating time, tympanic membrane (TM) perforation, and postoperative taste disturbance, pain, and dizziness. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous outcomes and weighted mean difference (WMD) with 95% CI for continuous outcomes. A confidence interval starting above 1.0 was considered as statistically significant. I2 and χ2 tests were used to quantify statistical heterogeneity. We used funnel plots to look for publication bias and performed a sensitivity analysis. Results Six nonrandomized cohort studies were eligible. The primary outcomes were ABG < 10 dB: OR = 1.80 (95% CI: 0.96 to 3.38), ABG = 11 dB to 20 dB: OR = 1.49 (95% CI: 0.76 to 2.93), ABG > 20 dB: OR = 2.51 (95% CI: 0.77 to 8.22), and chorda tympani injury: OR = 3.51 (95% CI: 1.55 to 7.93). Secondary outcomes were taste: OR = 2.36 (95% CI: 1.01 to 5.51), average operation time: WMD = 0.14 (95% CI: −11.69 to 11.98), TM perforation: OR = 1.70 (95% CI: 0.44 to 6.58); pain: OR = 0.84 (95% CI: 0.36 to 1.96), and dizziness: OR = 2.15 (95% CI: 0.94 to 4.89). Conclusions Endoscopic stapes surgery is a valid alternative to the microscope. Level of Evidence 2a Laryngoscope, 130: 2019–2027, 2020

Otosclerosis: Experience With Stapes Surgery

“…Now the endoscopes have become the modern way of visualization in the surgical domain [19]. Recent studies on endoscopic stapes surgeries and outcomes have reported excellent audiological success rates [15,18]. All patients in the current study underwent conventional microscopic middle ear surgery.…”

“…The microscope is the conventional method used for middle ear surgeries, and the endoscope has been recently utilized as an alternative technique to view middle ear structures [15,16]. A microscope allows binocular vision and freedom of both hands with an unobstructed direct view of the operating field [17,18]. Now the endoscopes have become the modern way of visualization in the surgical domain [19].…”

Functional Results and Learning Curve of Endoscopic Stapes Surgery: A 10‐Year Experience

“…22 Statistically significant changes of the postoperative BC threshold were not reported: only 1% of cases in our series showed postoperative SNHL, which is close to data reported in publications both on microscopic and endoscopic SS so far. [22][23][24] Similarly, a review of over 3,000 cases reported a rate of 0.5% of postoperative SNHL in microscopic stapedotomy. 25 Direct trauma due to onehanded surgical maneuvers and heating caused by the light of the endoscope have been frequently questioned as possible risks for inner ear damage during EES 26 ; however, our results did not support this hypothesis, as the use of the endoscope has proven to be a safe tool in our large cohort, as previously described.…”

“…A metaanalysis by Koukkoullis et al on six nonrandomized studies concluded that the hearing outcomes of the endoscopic approach are similar to microscopic ones. 24 Another meta-analysis by Nikolaos et al suggested superiority of endoscopic stapedotomy over microscopic in terms of functional results. 23 However, this was based on four studies only, and our results could not confirm this hypothesis.…”

“…29 The rate of postoperative taste disturbance varies notably among different reports: a range between 0% and 60% is described in microscopic cohorts, with an average of 8.11%, 23,29 although for endoscopic surgery, the highest dysgeusia rate (29.6%) was reported by Nassiri et al 30 Two meta-analyses suggested that endoscopic SS is burdened by a low rate of postoperative taste disturbance. 23,24 This might be due to limited drilling of the posterior wall of the scutum and better visualization of the ChT.…”