Endoscopic ear surgery continues to increase in popularity with an expanding range of applications in otology. The variety of angled scopes allow for superior visualisation of the surgical field and difficult to reach areas. However, use of endoscopes reduce the space available for instrumentation down the canal and can make bimanual surgery more difficult. There is also a significant learning curve associated with endoscopic ear surgery. The authors reviewed the outcomes of 118 adult patients who underwent transcanal ossiculoplasty using either an endoscope or operating microscope. Indications for surgery included CT-confirmed ossicular discontinuity with an air bone gap (ABG) >25dB resulting from mucosal chronic otitis media, a retraction pocket or for hearing reconstruction following a previous canal wall up procedure without residual disease. Patients were randomised into endoscopic or microscopic groups with all procedures performed by a single experienced otologist. There was no significant difference in operative time. ABG closure was significantly better with PORP procedures at one-month post-op using an endoscope, however at three and six months there was no significant difference in ABG closure in patients undergoing either PORP or TORP. This study suggests that the improved visualisation afforded by otoendoscopes may translate to improved outcomes, at least in the early postoperative period. The study adds to the body of evidence investigating the efficacy of endoscopic ear surgery and invites further research comparing endoscopic to conventional microscope techniques.
Outcomes following endoscopic vs. microscopic ossiculoplasty
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