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

Abstract

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. 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 12months postoperatively and compared to pre-operative levels. Other variables included were the condition of stapes and reconstruction material used. 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 (43.4dB pre-operatively, 36.2dB postoperatively), BC (20.3dB pre-operatively, 17.6dB postoperatively), and ABG (21.8dB pre-operatively, 16.7dB postoperatively) in the total cohort. Both groups achieved an ABG better than 20dB; 72% in TEES, 73% in the microscopic group, and there was no significant difference. There was no change in hearing at 12months when compared to 3months. No statistically significant difference was noted based on stapes condition, type of material used for ossiculoplasty, or tympanic membrane graft. TEES is safe and as effective as microsurgery in ossiculoplasty with possibly much less pain and morbidity.