Endoscopic Stapes Surgery Is a Valid Alternative to the Microscope

Do intraoperative and postoperative outcomes of endoscopic and microscopic stapes surgery show evidence that the former is a better alternative than the latter?

Bottom Line: Endoscopic and microscopic stapes surgery have similar audiological success, but some data suggest lower chorda tympani injury and postoperative taste disturbance risk with the endoscope.

Background: The microscope provides reliable outcomes in stapes surgery but is disadvantaged by the need for an unobstructed view of the operating area. The endoscope can more easily provide a close-up view during surgery but has other drawbacks. No meta-analysis of evidence has compared outcomes of the two modalities.

Study Design: Systematic literature review and meta-analysis using multiple databases.

Setting: Department of Otorhinolaryngology-Head and Neck Surgery, University of Pécs Medical School, Pécs, Hungary.

Synopsis: To test their hypothesis that endoscopy performs better than microscopy in stapes surgery, researchers reviewed literature from multiple databases, from inception to June 6, 2018, from studies that compared the modalities. Six of 3,017 articles were eligible for qualitative and quantitative synthesis. All were nonrandomized cohort studies, with the exposure group being patients who underwent fully endoscopic stapes surgery and the control group being patients who underwent microscopic stapes surgery. The primary outcomes considered were postoperative airborne gap and chorda tympani nerve injury; secondary outcomes were average operating time, tympanic membrane perforation, and postoperative taste disturbance, pain, and dizziness. The most statistically significant difference was chorda tympani nerve injury, which was shown to be more than three times likely to happen with microscopic stapes surgery than with the endoscope. Limitations included an uncertain risk of bias in some studies that reduced the level of evidence, and the inclusion of only articles that directly compared the two surgeries, which limited the data pool.

Citation: Koukkoullis A, Tóth I, Gede N, et al. Endoscope versus microscopic stapes surgery outcomes: a meta-analysis and systematic review. Laryngoscope. 130;8:2019-2027.