Endoscopic stapes surgery outcomes and complication rates: a systematic review.

Abstract

These days, the gold standard procedure for otosclerosis treatment is stapes surgery. The endoscopic approach of the procedure is gaining popularity as endoscopic ear surgery develops across the globe. The main objective of this study is to gather and compile well-documented and reliable data regarding surgical outcomes for the endoscopic approach to stapes surgery up to this date. Publications in English were searched in the PUBMED/MEDLINE database and were systematically reviewed. A total of 16 articles were reviewed according to the inclusion criteria, obtaining a total of 573 patients managed surgically for otosclerosis, using an endoscopic approach. Data were systematically extracted and compared across variables. Data were obtained as follows: mean age of 43years; female proportion of 60%; 3mm endoscope diameter of 51%, 4mm of 39%; titanium piston-type prostheses of 52% and Teflon of 48%; length of the prosthesis (mode) was 4.5mm; 0.6mm diameter of the piston of 81% and 0.4mm of 19%; mean surgical time was 55min. Hearing results, mean preoperative air-bone gap (ABG) 31dB; mean postoperative ABG 9dB; ABG improvement of 22dB; an ABG closure rate to 20dB or less of 92% and an ABG closure rate to 10dB or less of 77%. Complication rates: intraoperative tympanic membrane perforation of 5%; postoperative vertigo of 11%; postoperative dysgeusia of 10%; reported a postoperative neurosensorial hearing loss of 0.2%; reported gusher phenomenon of one case (0.2%). Endoscopic stapes surgery is completely achievable using 0º angle and 4-mm-diameter sinus surgery endoscope. Instrument availability should not be an obstacle to the development of this type of surgery in any otolaryngology department. Audiological outcomes are comparable to microscopic approaches.