Bye-Bye Binoculars: Comparing Efficacy, Safety, and OR Utilization of Endoscopic Versus Otomicroscopic Approaches to Middle Ear Surgery

By June 7, 2019

Holt, Justin1; Benuzillo, Jose2; Mosen, David2; Grosz, Anna3
1 Department of Otolaryngology – Head and Neck Surgery, Oregon Health & Science University, Portland, OR, USA;
2 Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA;
3 Department of Head and Neck Surgery, Kaiser Permanente Northwest, Clackamas, OR, USA.

This study compares outcomes and complication rates of endoscopic to microscopic surgical approaches for chronic ear disease and compares the associated morbidity and operating room utilization of each.

Study design: Retrospective review of 131 tympanoplasties and tympanomastoidectomies by a single surgeon
Setting: Large, nonprofit, integrated health system
Patients/Interventions: Included patients underwent otologic surgery primarily utilizing either the otomicroscope (66 cases from 2011-14) or the endoscope (65 cases from 2014-17) for indications of conductive hearing loss, tympanic membrane (TM) perforation and/or cholesteatoma

Main outcome measure(s): Perforation closure, cholesteatoma eradication, and hearing preservation/restoration. Complications evaluated are hearing loss, iatrogenic cholesteatoma, and perforation. Secondary outcomes evaluated are use of post-auricular incision, procedure time, and total OR time.

The two groups were similar in demographics, procedure side, history of prior surgery, and primary diagnosis with exception of cholesteatoma, with fewer in the endoscopic group (25 vs 39, p=0.01). There were fewer mastoidectomies in the endoscopic group (20 vs 34, p=0.02). Ossiculoplasty rates were similar (14 vs 11, p=0.51). There were no significant differences in TM closure (86% vs 91%, p=0.4), hearing improvement with ossicular chain reconstruction (63% vs 70%, p=0.73), and cholesteatoma recurrence (10% vs 14%, p=0.25) with the endoscopic versus microscopic approach, respectively. Complications also occurred at comparable rates but too infrequently for statistical analysis. On average, endoscopic approaches utilized significantly fewer post-auricular incisions (18 vs 46, p=0.00) and required significantly less total OR time (111 vs 160min, p=0.00) with similar procedure times (103 vs 116min, p=0.19)

An endoscopic approach can be safely used to perform chronic ear surgery, yielding comparable outcomes to the microscopic approach with relatively less patient morbidity and OR time.