Objective: To evaluate the effectiveness, functional outcomes, and surgical advantages of endoscopic stapes surgery in patients with otosclerosis, based on a three-year experience at the Otolaryngology Department of Avicenne Military Hospital in Marrakech. Materials and Methods: We conducted a retrospective study of patients operated on for otosclerosis between January 2020 and January 2023. All surgeries were performed using a transcanal endoscopic approach, involving a fully calibrated small-fenestra platinectomy and titanium prosthesis insertion, without the use of a surgical microscope. Patients were assessed pre- and postoperatively with audiometry (pure-tone average, air–bone gap), tympanometry, and postoperative functional evaluation. Results: A total of 36 patients were included (28 women, 8 men; mean age: 38.5 years). Unilateral stapedotomy was performed in all cases, and no conversion to microscopic surgery was required. The mean preoperative air–bone gap (ABG) was 33 dB. At 3 months postoperative follow-up, closure of the ABG to <10 dB was achieved in 83%, with a mean postoperative ABG of 8.2 dB. No severe complications occurred; minor transient vertigo was reported in 14% of patients, and temporary taste disturbance (chorda tympani stretch) in 11%. No persistent tympanic perforations or sensorineural hearing losses were observed. Conclusion: Endoscopic stapes surgery represents an efficient, safe, and minimally invasive alternative to traditional microscopic stapes surgery. Its advantages include wide-angle visualization, improved exposure of the oval window niche, and enhanced identification of anatomical variations. Based on our experience, endoscopic surgery offers excellent hearing outcomes and low complication rates, making it a valuable technique in modern otologic practice.

Background:The aim of the study was to measure the distance of the tympanic nerve to the oval window and round window niche in adult cadavers for evaluating its usability as an anatomical landmark during middle ear-related surgeries, including stapedotomy and cochleostomy, and for preventing its iatrogenic damage during surgical practices such as otosclerosis surgery and cochlear implantation.Methods:The middle ears of 10 adult cadavers aged 74.70 ± 14.56 years were bilaterally dissected with the help of an endoscope and microscope to measure the distance of tympanic nerve to round window niche and oval window. Results:Tympanic nerve was found as 1.60 ± 0.86 mm (range, 0-3.11 mm) and 1.55 ± 0.38 mm (range, 1.04-2.20 mm) away from round window niche and oval window, respectively. In relation to the quantitative values of these 2 distances, neither right–left nor male–female significant differences were determined (P > .05). Tympanic nerve was observed in all temporal bones. In terms of the shape and twigs of tympanic nerve, extreme variations among cadaveric temporal bones were determined. Tympanic nerve-round window niche distance between 0-1 mm was defined as type 1 (20%), between 1 and 2 mm as type 2 (45%), between 2 and 3 mm as type 3 (30%), and between 3 and 4 mm as type 4 (5%).Conclusion:Tympanic nerve may be vulnerable at round window niche- or oval window-related surgeries (e.g., cochleostomy).

Rationale:A case study on the qualification and treatment of profound hearing loss with a cochlear implant in a patient with a positive Tullio effect is described. To our knowledge this is the first such case reported in the literature.Patient concerns:A 46-year-old woman was admitted due to sudden hearing loss in the right ear (RE). The patient had suffered from bilateral hearing loss since childhood and was fitted with hearing aids on the RE successfully, in contrast to the left ear. While undergoing pure-tone audiometry, a positive Tullio effect was observed in the RE. The average hearing threshold for the RE was 95 dB. Due to the lack of effective treatment for sudden hearing loss, the patient was qualified for cochlear implantation. The patient’s attempts to place a hearing aid on the RE resulted in dizziness.Diagnoses:Computed tomography excluded the presence of a perilymphatic fistula, which could have been the cause of the patient’s vertigo.Interventions:During the surgical procedure of cochlear implantation, considering the possible mechanisms of the Tullio effect, the incus was removed and the niche of the oval window was filled with fragments of connective tissue. The postoperative course was uneventful.Outcomes:Three months after implantation, speech intelligibility in the free field was 80% of the correctly repeated elements of the numerical test, at 65 dB sound pressure level. An acoustic stimulation test was performed during tonal audiometry and no preexisting symptoms were observed.Lessons:A positive Tullio effect does not contraindicate treating hearing loss by means of cochlear implantation. When the Tullio effect is present, it is necessary to exclude presence of perilymphatic fistula. During cochlear implant surgery, in a patient with a positive Tullio effect, it is reasonable to disconnect the ossicular chain with the simultaneous sealing of the oval window niche.

<b>Introduction:</b> Congenital otogenic CSF leak is a rare cause of meningitis. The underlying reason may be a defect of the fundus of internal auditory meatus with pathological communication with the inner ear and CSF leak to middle ear space. This condition requires surgical closure. </br></br> <b>Case report:</b> A 9-year-old boy with a history of recurrent meningitis – 3 episodes. During the last episode, β-2 transferrin test from ear fluid was positive. The patient complained of leakage of clear fluid through the nose on the right side. Otoscopy revealed a bulging tympanic membrane on the right side. The right ear was deaf with normal hearing on the left side. HRCT revealed congenital deformity of the right inner ear. Right side lateral petrosectomy with blind sac closure of the right external auditory canal was performed. During surgery there was an extensive CSF leak through the oval window niche due to a lack of the stapes footplate in the anterior part. Recovery was uneventful. After 24 months of follow up, no more leakage through the nose was observed. Control magnetic resonance performed one year after surgery showed no CSF in the mastoid cavity. </br></br> <b>Discussion:</b> Inner ear malformations are a rare cause of meningitis, and the most common sites of congenital otogenic CSF leakage include the oval and round window. Surgical closure is the only solution in such cases. Several methods of sealing the inner ear space were described in the literature. Vestibular packing and stapedectomy were most frequently used. However, recurrences were stated in up to 1/2 of cases. Such a risk can be limited with lateral petrosectomy. For this reason, LP can be considered as the treatment of choice in congenital spontaneous otogenic cerebrospinal fluid leak. </br></br> <b>Conclusion:</b> Every case of recurrent meningitis in children should be investigated with a suspicion of congenital ear malformation with spontaneous CSF leakage. Lateral petrosectomy is a safe and effective procedure for cases of otogenic CSF leak with a low risk of recurrence.

In recent years there has been an increasing trend in the use of the endoscope to treat a variety of middle ear pathologies, including otosclerosis. Several studies comparing traditional microscopic and endoscopic stapes surgery have reported similar hearing results and an overall low rate of complications. The endoscope has unraveled its full potential in demanding settings of stapes surgery, such as unfavorable anatomy of the oval window niche or revision cases. Reduced manipulation of the chorda tympani and low rate of post-operative dysgeusia are further benefits to mention for endoscopic stapes surgery. Being a one-handed technique, management of bleeding, positioning, and crimping of the prosthesis may be challenging for novice endoscopic surgeons, so some training in endoscopic ear surgery is recommended before performing endoscopic stapedotomy. The problem of sharing the surgical field between the endoscope and the operating instruments could be easily overcome if proper instruments positioning is understood. One-handed bleeding control in the narrow space of the ear canal may represent an issue during the elevation of the tympano-meatal flap, possibly discouraging the surgeon since the preliminary steps of surgery. Following appropriate technique to raise the flap and the collaboration with the anesthesiology team in keeping the blood pressure low guarantee an adequate bleeding control in most cases. The aim of this article is to describe the entire surgical procedure of a transcanal exclusive endoscopic stapedotomy, from operating room set up and patient positioning to post-operative care. A step-by-step description of the surgical maneuvers with technical hints is reported, to guide the surgeon across the procedure and allow any ear surgeon to perform stapes surgery endoscopically.

To study spectrum of high resolution computed tomography (HRCT) imaging findings in otosclerosis, to predict approximate length of prosthesis required from pre-operative HRCT measurements and to correlate between oval window niche (OWN) height preoperatively and difficulty in introducing foot plate perforator during surgery. A cross sectional study was conducted on 23 patients with a clinical diagnosis of otosclerosis from September 2018 to July 2020. Sensitivity of HRCT in detecting otosclerosis, correlation between pre-operative incudo-stapedial length (ISL) and intra operative prosthesis length, and correlation between OWN height and difficulty in introducing perforator were sought. The mean age of 23 patients studied was 39.9years with a female preponderance of 56.5%. 17 out of 19 patients with foci of otosclerosis during surgery had HRCT findings of otosclerosis providing a sensitivity of 89.5%. Mean OWN height obtained was 1.29mm preoperatively and a cut off value of 1.325mm found using receiver operating characteristic curve method classifying OWN height as narrow or normal. Mean ISL measured pre operatively was 4.25mm and mean length of prosthesis used was 4.56mm with significant positive correlation using intraclass correlation coefficient method with correlation coefficient = 0.879. HRCT is an invaluable modality aiding the surgeon to detect otosclerotic foci with high sensitivity, identify thick obliterative otosclerotic foci requiring additional drilling, to predict the length of prosthesis used and to predict difficulties in approaching footplate when OWN height is below 1.325mm.

Introduction: Although operating microscope is used worldwide for stapes surgery, the use of endoscopes would provide much benefit such as good panoramic view of middle ear and easy accessibility of the oval window area, stapes, and facial nerve. Objective: We aimed to analyze our experiences of endoscopic transcanal stapedotomy performed at a tertiary care teaching hospital of Eastern India. Materials and Methods: This prospective study was done at the Department of Otorhinolaryngology between March 2017 and April 2019. The patients were diagnosed as having otosclerosis with fulfilling the selection criteria. All underwent endoscopic transcanal stapedotomy. Results: Out of 52 patients those underwent endoscopic transcanal stapedotomy, there were 28 females and 24 males. The mean age was 32.40 years. The mean operation time was 35.43 min. The mean preoperative air–bone gap (ABG) was 34.84 dB, whereas the mean postoperative ABG was 9.81 dB. Tympanomeatal flap tear was seen in one case. One case showed chorda tympani injury and two patients presented with vertigo after surgery. No other complications were seen after endoscopic stapedotomy. Conclusion: The important advantages of endoscopic stapedotomy are good-quality visualization with identification of vital parts of the middle ear cleft, minimal handling to the chorda tympani nerve with almost no curettage of the scutum. The development of endoscopic ear surgery techniques promises the change the way we approach for stapes surgery. The wide field view of endoscope helps the surgeon to visualize better the middle ear recess, especially oval window niche and stapes.

To evaluate the reasons for persistent draining ear and cholesteatoma recidivism following canal wall down (CWD) tympanomastoidectomy by studying the sensitivity of high-resolution computed tomography (HRCT) scanning in different potential etiologies, corroborating through appropriate surgical intervention, and thereby, to suggest proper preventive measures. In this observational study, 32 chronic, refractory draining ears were subjected to revision surgery following a radical or a modified radical mastoidectomy. Besides disease (cholesteatoma/granulations) eradication, pitfalls of the primary surgeries were addressed. Data were interpreted for studying the epidemiologic profile, the clinical presentation at recurrence, the type of primary surgery, the sites of recidivism, the probable causes, and the best possible management at revision. Of the 32 patients/ears, 23 had residual/recurrent cholesteatoma. Major reasons were inadequate disease clearance, contracted/inadequate conchomeatoplasty, no cavity obliteration, and inappropriate bone work. HRCT predicted persistent bridge and lateral semicircular canal dehiscence with 100%, and ossicular integrity and bony overhang with >80% sensitivity. Sinus tympani and oval window niche were the commonest sites of recurrence. At revision, radical/modified radical mastoidectomies were associated with cavity obliteration and appropriate revision of conchomeatoplasty in 28 patients. Recurrence of cholesteatoma/granulations is an important cause for chronic drainage from post-CWD cavities. Revision surgery explores the surgical pitfalls, and ensures clearance of disease from hidden areas, adequate bone work, and optimum conchomeatoplasty following cavity obliteration to provide a safe, dry ear with hearing improvement whenever feasible.

Objective:The aim of this study to compare the outcome of endoscopic with that of microscopic stapedectomy. Methods:This comparative study involved a prospective analysis of patients with conductive hearing loss who underwent stapedectomy at the department of Otorhinolayngology, Assiut University hospital between July 2015 and October 2017. The patients were divided into two groups: Patients in group I were operated with endoscope and patients in group II were operated with microscope. Pure tone audiometry was carried out in all patients preoperatively and postoperatively. Air and bone conduction thresholds were measured at frequencies of 500, 1000, 2000 and 4000 HZ and the median and interquartile range (IQ) of the pre and postoperative air-bone gap were noted. Extent of bone work at the posterosuperior part of the external auditory canal, accessibility to the oval window and manipulation of the chorda tympani nerve, postoperative complications and hearing results were also noted and compared between the two groups. Results:The median preoperative air-bone gap was 35.8 dB (30.4-45.03) in group I (endoscopic) and 35.85 dB (32.1-43.38) in group II (microscopic) whereas the median postoperative air-bone gap was 16.7 dB (5-39.58) in group I and 15.85 dB (10 -19.58) in group II. There was no statistical difference for hearing results between both groups. The need for bone work and manipulation of the chorda tympani nerve for better visualization was more in microscopic group than the endoscopic group and the difference between both groups was statistically significant. The incidence of complications in both groups was nearly the same in both groups and the difference between them was statistically insignificant. Conclusion: Endoscopic stapedectomy has many advantages over microscopic stapedectomy as better visualization, and easy accessibility to the stapes, oval window niche, and facial nerve. Drilling of the posterosuperior part of the external auditory canal or removal of the scutum and manipulation of the chorda tympani nerve are less frequent with the endoscopic technique

The purpose of this study is to categorize anomalous tympanic facial nerve (FN) on high-resolution computed tomography (HRCT) and to determinate the significance of associated temporal bone anomalies and congenital syndromes without microtia in patients with hearing loss. A retrospective analysis of HRCT findings in 30 temporal bones in 18 patients with anomalous FN was performed. Abnormalities of the tympanic FN were categorized as follows: category 1: FN medially positioned, but above the oval window; category 2: FN in the oval window niche; and category 3: FN below the oval window. Potential associated findings that were assessed included stapes abnormalities, oval window atresia, and inner ear anomalies, as well as the presence of a known congenital syndrome with hearing loss. The most common type of anomalous tympanic FN was category 1 (67%, n = 20), following by group 2 (20%, n = 6) and group 3 (13%, n = 4). Stapes anomalies were detected in 77% of temporal bones (n = 23), oval window atresia was detected in 43% of temporal bones (n = 13), and inner ear anomalies were detected in 70% of temporal bones (n = 21). Anomalous tympanic facial nerves in temporal bone with conductive hearing loss were often (60%) not associated with oval window atresia. The combination of aberrant tympanic FN and inner ear anomalies was significantly (P = .038) associated with a known congenital syndrome (6 patients), including CHARGE syndrome, oculo-auriculo-vertebral spectrum, Pierre-Robin sequences, and Down syndrome. Therefore, an anomalous tympanic FN in conjunction with inner ear anomalies appears to be a biomarker for certain congenital syndromes with hearing loss in the absence of microtia.

The surgical treatment of otosclerosis can be challenging in case of anatomical abnormalities or variations of the oval window niche (OWN) area, as in very narrow OWN or in an overhanging facial nerve. The aim of the present study was to explore the role of endoscopic stapes surgery in cases with difficult OWN anatomy. Patients undergoing endoscopic stapes surgery from 2008 to 2017, which fulfilled the CT scan criteria for a "difficult" anatomical condition, according to the measurements and cut-off values defined in the literature, were retrospectively selected. The intraoperative endoscopic view of the anatomical details and surgical difficulties were analysed through the review of the operative videos. Finally, a statistical analysis of the relationship between endoscopic visualization of anatomical details and radiological measurements was carried out. Eighteen out of 205 patients (8.7%) were included in the study. The 94.4% of patients obtained an optimal endoscopic exposure and visualization of all the anatomical details considered in the study, during each step of stapes surgery. The OWN measurements (width, depth and facial-promontory angle) did not affect significantly the endoscopic surgical exposure of the footplate or any of the other anatomical details. The anatomic features of the oval window area which reduce the visualization in microscopic surgery, did not affect the surgical exposure in endoscopic stapes surgery. Patients having a difficult anatomy of the OWN can be treated safely with the endoscopic approach. In the case of a predicted "difficult anatomy", the endoscopic approach can be considered a viable option.

The present-day Russian literature on stapes surgery has no sufficient information about the efficacy and safety of using the assistance facilities such as microdrills and laser systems, as well as their advantages and drawbacks and the criteria of their rational choice. The objective of the study is to assess the indications, safety, and efficacy of the use of CO2 laser and micro drill at the stage of stapedotomy in the patients with otosclerosis. Based on the analysis of the results of examination and surgical treatment of 100 patients with various forms of otosclerosis, who underwent a piston stapoplasty (50 patients) and a method of installation of metallized stapes prosthesis on an autovenous graft (50 patients) using a CO2-laser system (n = 50) and micro drill (n = 50), the article presents the data on their safe use and efficacy, as well as the criteria of selection of the assistance facilities. It has been revealed that the choice of stapedoplasty method is affected by the use of temporal bones in the CT diagnostics, the expansion of otosclerosis foci, the anatomical structure of the oval window niche and the specific features of the surgery. The authors pointed out the advantage of efficacy of the method of installation of stapes prosthesis on an autovenous graft after extensive stapedotomy, regardless the assistance facilities.

The oval window is an important structure with regard to stapes surgeries, including stapedotomy for the treatment of otosclerosis. Recent study of perioperative imaging of the oval window has revealed that oval window niche height can indicate both operative difficulty and subjective discomfort during otosclerosis surgery. With regard to shape, structures incorporated into the oval window niche, such as cartilage grafts, must be compatible with the shape of the oval window. Despite the clinical importance of the oval window, there is little information regarding its size and shape. This study assessed oval window size and shape via micro-computed tomography paired with modern morphometric methodology in the fetal, infant, child, and adult populations. Additionally, the study compared oval window size and shape between sexes and between left- and right-sided ears. No significant differences were found among traditional morphometric parameters among age groups, sides, or sexes. However, geometric morphometric methods revealed shape differences between age groups. Further, geometric morphometric methods provided the average oval window shape and most-likely shape variance. Beyond demonstrating oval window size and shape variation, the results of this report will aid in identifying patients among whom anatomical variation may contribute to surgical difficulty and surgeon discomfort, or otherwise warrant preoperative adaptations for the incorporation of materials into and around the oval window.

Abstract Introduction The best surgical treatment for otosclerosis is stapedotomy. Various methods are used for creating fenestra, including manual pick, laser, and Skeeter drill. In India, despite several studies on the hearing outcomes of otosclerosis surgery, there exist few studies on small fenestra stapedotomy performed using a microdrill. Hence, we designed this study with the objectives of examining the demographic profile, hearing improvement after surgery, anatomical variations encountered at surgery, effect of microdrill use on bone conduction (BC), and postoperative complications of small fenestra stapedotomy. Methods A prospective study was conducted for 63 patients of otosclerosis. Stapedotomy was performed by the same surgeon on all patients by a transcanal approach under local anesthesia. Small fenestra stapedotomy was performed using Skeeter microdrill. The study proforma included sociodemographic profile, clinical history, examination, audiometry, surgical details, and postoperative findings. Descriptive statistics was used to analyze the data. Results Our study demonstrated a male preponderance (58.7%) over females (41.3%). Of the study population, 31.7% reported a family history of otosclerosis, whereas nine (14.28%) individuals had a history of measles. All four different types of footplates were identified. Most of them were either type 1 (52.4%) or 2 (34.9%). In most cases, the diameter was 0.4 mm (96.8%), a majority of the cases having either 4.25 (22.2%) or 4.5 mm (63.5%) long piston. After stapes surgery, the mean ABG reduced from 39.48 (±9.17) to 13.89 (±7.99) dB. The mean worsening in postoperative BC was only 3.035 dB. Use of microdrill caused only a slight and statistically insignificant decline in BC. Anatomical variation of a narrow oval window niche may require drilling of the bone. In practice, this drilling does not adversely affect the BC of the patient. Some facial nerve variation (partially overhanging facial nerve and exposed facial nerve) may be encountered, but it does not affect the facial nerve function or hearing improvement. On rare occasions, facial paresis may occur on the fifth to sixth postoperative day, even without facial nerve handling. This can be managed conservatively with oral steroids with favorable results. Taste alterations are seen even when the chorda handling is minimal. Complaints are most common in the first few weeks after surgery. Over a 6-month period, only 5% of the patients who underwent surgery were found to have altered taste sensation. Conclusion Microdrill-assisted small fenestra stapedotomy, performed under local anesthesia, with placement of a 0.4-mm Teflon piston for patients with otosclerosis produces excellent results. The complication rates are low, and the surgery has a positive impact on the patient's hearing.

Objective:To compare audiometric results between the standard total ossicular replacement prosthesis (TORP-S) and a new fat interposition total ossicular replacement prosthesis (TORP-F) in pediatric and adult patients and to assess the complication and the undesirable outcome.Study design:This is a retrospective study.Methods:This study included 104 patients who had undergone titanium implants with TORP-F and 54 patients who had undergone the procedure with TORP-S between 2008 and 2013 in our tertiary care centers. The new technique consists of interposing a fat graft between the 4 legs of the universal titanium prosthesis (Medtronic Xomed Inc, Jacksonville, FL, USA) to provide a more stable TORP in the ovale window niche. Normally, this prosthesis is designed to fit on the stapes’ head as a partial ossicular replacement prosthesis.Results:The postoperative air-bone gap less than 25 dB for the combined cohort was 69.2% and 41.7% for the TORP-F and the TORP-S groups, respectively. The mean follow-up was 17 months postoperatively. By stratifying data, the pediatric cohort shows 56.5% in the TORP-F group (n = 52) compared with 40% in the TORP-S group (n = 29). However, the adult cohort shows 79.3% in the TORP-F group (n = 52) compared with 43.75% in the TORP-S group (n = 25). These improvements in hearing were statistically significant. There were no statistically significant differences in the speech discrimination scores. The only undesirable outcome that was statistically different between the 2 groups was the prosthesis displacement: 7% in the TORP-F group compared with 19% in the TORP-S group (P = .03).Conclusions:The interposition of a fat graft between the legs of the titanium implants (TORP-F) provides superior hearing results compared with a standard procedure (TORP-S) in pediatric and adult populations because of its better stability in the oval window niche.

Endoscopic stapedotomy: Merits and demerits

Stapes surgery for otosclerosis can be challenging if access to the oval window niche is restricted. The aim of this study was to determine the accuracy of the computed tomographic (CT) scan in the evaluation of anatomical distances, and to analyze its reliability in predicting surgical technical difficulties. A total of 96 patients (101 ears) were enrolled in a prospective study between 2012 and May 2015. During surgery, we evaluated the distance D1 between the stapes and the facial nerve, distance D2 between the promontory and the facial nerve after ablation of the superstructure, and the intraoperative discomfort of the surgeon. On preoperative CT scans, we measured the width and depth of the oval window niche, and the angle formed by two axes starting from the center-point of the footplate, the first tangential to the superior wall of the promontory, and the second tangential to the inferior wall of the fallopian canal. Intraoperative distances D1 and D2 were correlated with the width of the oval window and with the facial-promontory angle measured on imaging. CT scan measurements of the facial-promontory angle and width of the oval window were associated with the degree of discomfort of the surgeon. The cut-off threshold for intraoperative subjective discomfort was computed as 1.1 mm for the width of the oval window niche, with a sensibility of 71% and a specificity of 84%. Preoperative imaging analysis of the oval window width and the facialpromontory angle can predict operative difficulty in otosclerosis surgery.

Conclusions: Triamcinolone-soaked fascia seems to show better hearing improvement when added to tympanotomy for sudden idiopathic sensorineural hearing loss (SSHL), compared to fascia round window occlusion without triamcinolone.Objectives: To analyse if adding triamcinolone to sealing the round and oval window niches with fascia results in improved audiological outcome for acute SNHL.Methods: Fifty-three patients (27m:43 ± 12 years, 26f:45 ± 14 years) with acute SSHL ≥50dB over 3 frequencies, who failed primary therapy, underwent transcanal tympanotomy. Twenty-five patients (Group A;cortisone:14m, 11f:46 ± 9 years) received sealing of the round and oval window with fascia soaked in triamcinolone (1ml; 40mg/ml) and 28 controls (Group B;no-cortisone:13m, 15f, 42 ± 12 years) without triamcinolone. Frequency specific and pure tone average (PTA =500–1000–2000–3000Hz) results were compared between Group A and B pre- and postoperatively.Results: In Group A the PTA improved by ≥10dB in 21/25(83%) cases; in Group B 18/28(63%). Group A showed a statistically significantly better improvement across all frequencies, while linear regression revealed a significant decrease of posttherapeutic PTA to 94.96% of the initial PTA (p = .037). The overall PTA improved by 24dB. Group A improved from 73dB to 41dB(-32dB) PTA, Group B improved from 76dB to 56dB PTA (-20dB) (p < .05). Group A showed a significant additional decrease of 12.8dB (p < .001).

ObjectivesThe purpose of the present work was to evaluate the role of otoendoscopy in performing stapedotomy in clinically otosclerotic patients.Patients and methodsTwenty patients presenting with clinically diagnosed otosclerosis were randomly selected from the outpatient ENT clinic in a tertiary referral Institutional Hospital. All patients were subjected to transcanal totally endoscopic stapes surgery (TTESS) from early 2013 to the fall of 2014.MethodsThis prospective study demonstrated the detailed technique of TTESS using mainly 0° lens of 14 cm length rigid endoscope for elevating the tympanomeatal flap, handling the chorda tympani nerve, curettage of posterior bony canal wall, visualization of oval window niche structures, creation of stapedotomy, and accurate prosthesis insertion. Postoperative audiogram was performed after 2 months. Assessment of postoperative complications, especially change in taste sensation, was carried out.ResultsThe chorda tympani nerve was preserved in all cases. Two cases had change in taste sensation that was improved within 6 months postoperatively. There was a significant improvement in hearing. The preoperative air-bone gap mean value was 40.30±6.38, and the postoperative mean value was 7.15±4.27 (P=0.001), with complete closure of air-bone gap in four cases. No facial paralysis or tympanic membrane perforation was encountered during the follow-up period.ConclusionTranscanal totally endoscopic stapes surgery is a feasible and safe technique for the surgical management of conductive hearing loss associated with otosclerosis, which is recommended in bilateral and revision cases.

Chorda tympani nerve management in endoscopic stapes surgery