Microscopic versus endoscopic stapes surgery—a meta-analysis study

Abstract

Abstract Background The traditional approach for viewing middle ear structures during ear surgery is still the microscope, which provides both hands’ flexibility and binocular vision. The requirement for a clear, direct vision of the working zone is its primary disadvantage. The procedure was modified for the microscope by using an end-aural approach, drilling the bone canal, and then moving the patient and surgeon. However, the microscope has successfully demonstrated that it is the preferred tool for stapedectomy. Objective To compare endoscopic and microscopic interventions in stapes surgery regarding intraoperative and postoperative outcomes. Patients and methods The review was a meta-analytic and systematic review that included randomized controlled trials (RCT), case series, and retrospective studies which studied the comparison of microscopic and endoscopic stapes surgery; 15 articles published between 2014 and 2020 were included in our study. Data sources PubMed, Embase, and Cochrane Library were searched for studies published up to 2020. The inclusion criteria comprised randomized controlled trials, cohort studies, and case–control studies comparing microscopic and endoscopic stapes surgeries. Results Our results showed that the injury to the chorda tympani nerve was significantly higher in the microscopic group versus the endoscopic group. And also, as regards the operative times, it was significantly longer in the microscopic group versus the endoscopic group. But there is no significant difference as regards pain, dizziness, perforation of the tympanic membrane, delayed conductive hearing and postoperative air–bone gap improvement, and taste disturbance between both groups. Conclusion Technologically, safely, and promisingly, endoscopic stapes procedures are possible. All things considered, our research shows that both microscopic and endoscopic stapes surgery yields good audiological outcomes. A little amount of data, however, points to a decreased likelihood of chorda tympani injury and taste disturbance when using an endoscope. With comparable side effects to microscopic stapes surgery (pain, tympanic membrane perforation, taste disturbance, dizziness, and delayed conductive hearing), endoscopic stapes surgery seems like a feasible substitute. Endoscopic stapes surgery was found to need shorter operating times. In comparison to endoscopic groups, the postoperative air–bone gap increased considerably in the microscopic group. All of the studies consistently indicated better sight with the endoscope. This meta-analysis of the available data bolsters the application of endoscopic methods in stapes surgery.

Keywords

• Microscopic
• Endoscopic stapes surgery
• Air–bone gap