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. 2023 Jan;280(1):89-96.
doi: 10.1007/s00405-022-07451-2. Epub 2022 May 22.

Comparison of endoscopic vs microscopic ossiculoplasty: a study of 157 consecutive cases

Holli Coleman  1 , Theofano Tikka  1 , John Curran  1 , Arunachalam Iyer  2
Affiliations

Comparison of endoscopic vs microscopic ossiculoplasty: a study of 157 consecutive cases

Holli Coleman et al. Eur Arch Otorhinolaryngol. 2023 Jan.

Abstract

Purpose: The relatively new technique of trans-canal endoscopic ear surgery (TEES) when compared to microsurgery for ossiculoplasty has advantages of better visualization and no external incision but also has the disadvantage of being a one-handed procedure. Our study aimed to compare audiometric outcomes following ossiculoplasty performed via TESS with results of microsurgery.

Materials and methods: Data from a prospective audit of 157 consecutive patients who underwent ossiculoplasty by a single otologist from 2009 to 2018 was analyzed. TEES was introduced in the department in 2014; therefore, all patients before this period underwent microsurgery. Patients were classified by surgical approach, TEES, or microsurgery. Audiological outcomes were recorded at 3 and 12 months postoperatively and compared to pre-operative levels. Other variables included were the condition of stapes and reconstruction material used.

Results: Of the 157 cases, 50 were TEES and 107 were microsurgery (81 microscope only and 27 combined with endoscope). There was statistically significant improvement (p < 0.001) in AC (43.4 dB pre-operatively, 36.2 dB postoperatively), BC (20.3 dB pre-operatively, 17.6 dB postoperatively), and ABG (21.8 dB pre-operatively, 16.7 dB postoperatively) in the total cohort. Both groups achieved an ABG better than 20 dB; 72% in TEES, 73% in the microscopic group, and there was no significant difference. There was no change in hearing at 12 months when compared to 3 months. No statistically significant difference was noted based on stapes condition, type of material used for ossiculoplasty, or tympanic membrane graft.

Conclusion: TEES is safe and as effective as microsurgery in ossiculoplasty with possibly much less pain and morbidity.

Keywords: Endoscopic; Hearing loss; Ossiculoplasty; Tympanomastoidectomy; Tympanoplasty.

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