Endoscopic Stapedotomy: Overcoming Limitations and Improving Surgical Outcomes

Abstract

Background: Stapedotomy is being practiced as a preferred surgical modality for the management of otosclerosis. The operating microscope has been utilized as the conventional tool for stapes surgery over the years. However, certain shortcomings too have been observed. Endoscope provides better and wider field of vision than an operating microscope. Aims and Objectives: The study is aimed to compare the technical challenges faced during microscopic versus endoscopic stapedotomy. Material and Methods: Forty patients with diagnosed otosclerosis were randomly assigned into 2 groups- patients in first group underwent microscopic stapedotomy, while the other group underwent endoscopic stapedotomy. The 2 groups were then observed in terms of extent of the postero- superior canal bone curettage/drilling required for clear visualization of operating area, need for chorda tympani manoeuvring, visualization of the incudo- stapedial complex, operative time, ease of piston insertion, patient head positioning, post-operative pain, vertigo, effect on hearing and taste impairment. Result: Endoscopic stapedotomy offered better access to the oval window requiring less bone removal and chorda tympani manoeuvring. The operating time, pain post operatively, and taste impairment were significantly less in the endoscopic group. No significant difference was observed with respect to hearing outcome and post operative vertigo. Endoscopic stapedotomy had disadvantage of handling the endoscope with one hand and placing the piston with other. Conclusion: Endoscopic stapedotomy has clear cut advantage over microscopic stapedotomy in terms of the technicality and accessibility to the operating area.