Total endoscopic stapes surgery: Systematic review and pooled analysis of audiological outcomes

Abstract

Objective: This study evaluates the current evidence base for total endoscopic stapes surgery, specifically to establish current efficacy and safety of the technique within clinical practice.Data Sources: A systematic review of the literature on endoscopic stapes surgery was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist. A comprehensive search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials database for relevant publications for all available dates with appropriate Medical Subject Headings search criteria in January 2018.Study Selection: Out of the 160 articles identified in the search, 14 met the inclusion criteria for further analysis. Four of these were level III and 10 level IV evidence.Data Extraction: A pooled patient population of 314 individuals was analyzed. Data Synthesis: Documented postoperative air bone gap closure to within 20 dB was found in 95.3% of individuals (285 patients). Facial nerve palsy (temporary) occurred in three patients (0.6%), with all recovering. No total sensorineural hearing losses were recorded, but two moderate sensorineural hearing losses occurred (0.6%). Perilymph fistula was noted on four occasions (1.3%). Chorda tympani trauma was documented in 3.5% of cases, with taste disturbance documented in 13 patients (5%).Conclusions: Our pooled analysis uses the current published evidence to establish the complication rate and audiological outcome for the endoscopic approach to stapes surgery. These outcomes are comparable to those documented in traditional use of the microscope for stapedectomy.

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

“…21 Hall et al reported in a pooled analysis on 14 endoscopic studies that the rate of ABG closure to <20 db HL was found to be 95.3%, whereas closure to <10 db HL was 76.6%, which aligns closely with our results. 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.…”

“…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.…”

Perilymphatic Fistula: A Review of Classification, Etiology, Diagnosis, and Treatment

“…At first, PLFs were observed in post-stapedectomy patients where perilymph would leak around a prosthesis placed into the oval window due to a failure of the seal around or under the prosthesis ( 7 – 9 ). Though techniques for stapes surgery have advanced, PLFs still occur as a complication in ~1% of stapedotomy procedures ( 10 ) and may be present in up to one-third of individuals requiring revision stapedectomies ( 11 ).…”

Microscopic versus endoscopic stapes surgery: systematic review and meta-analysis

“…and Koukkoullis et al . 28–30 Exceptionally, Fang et al . observed a statistically significant difference in favour of the endoscopic technique, demonstrating its superiority.…”