Primary Endoscopic Stapedotomy

Abstract

Background: Otosclerosis is a progressive disease of the otic capsule which presents with conductive hearing loss with an intact tympanic membrane. The description of the disease was first given by Valsalva in 1704. Since then, several techniques are described for otosclerosis. All these procedures have traditionally been performed with microscope. New modifications of surgical techniques have been introduced time to time. The concept of minimally invasive surgical techniques has sprung up lately. Recent advances in optics such as high-definition endoscopes have revolutionized the surgeries in otology. Aim: The study aimed to study the feasibility of primary endoscopic stapedotomy. Objectives: (1) The objectives of the study were to evaluate Air-bone gap (ABG) closure in primary endoscopic stapedotomy and (2) to study intra- and post-operative complications in primary endoscopic stapedotomy. Methodology: Thirty patients with otosclerosis underwent stapedotomy using the standard 0.4 mm 18 cm endoscope and high-definition camera system. Results: Of the 30 cases, 17 were males and 13 were females, with a mean age of 39.84 years. A minimal removal of posterosuperior bony canal wall was required in 21 (70%) cases. The average operative time was 65 min. Among intraoperative complications, chorda tympani injury was seen in 2 (6%) cases, and incus subluxation and stapes footplate subluxation in 1 (3%) case each. Pure-tone audiograms done at an interval of 4 months demonstrated improvement across the three speech frequencies (500–2000 Hz) (50.2 dB vs. 23.7 dB). The average postoperative ABG was within 10 dB in twenty (66%) ears and between 10 and 25 dB in the rest ten (33%) ears. Conclusion: Endoscopic stapedotomy is a good alternative tool to conventional operating microscope. It offers better visualization, less trauma while elevating tympanomeatal flap flap, lesser bone curettage, and provides equivalent results.