Endoscopic Stapes Surgery: A Systematic Review

By June 7, 2019

Hoskison, E1; Harrop, E1; Jufas, N2; Kong, J1; Patel, N2; Saxby, A1
1 Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney Australia, University of Sydney;
2 Department of Otolaryngology Head and Neck Surgery, Royal North Shore Hospital, St Leonards, Sydney, Australia; University of Sydney; Macquarie University.

Introduction:
Stapedectomy surgery has evolved from its origins in 1956. The endoscope delivers a wide angled, contextual view of the stapes and associated pathology.  Endoscopic assisted stapes surgery offers a new perspective on this technically challenging surgery. This systematic review aims at establishing the audiological outcomes and complication rates of endoscopic stapes surgery.

Methods:
Data Sources:Six databases including PubMed, Medline, Cochrane database, AMED, EMBASE and CINAHL were searched to include the last 10 years. English language articles.
Study Selection: Papers including 5 or more adult cases included

Discussion:
Data Extraction: Articles and data were extracted according to PRISMA
Data Synthesis: Thirteen relevant papers were identified and were reviewed independently by two reviewers. 361 endoscopic assisted stapes surgeries were performed. All cases were performed with a totally endoscopic approach (Massachusetts Class 3). Post-operative temporary facial nerve weakness was reported in 3 patients (0.8%) with all cases resolving by 4 weeks; chorda tympani injury occurred in 21 cases (5.8%) and vertigo in 61 (16.9%). The audiometric outcomes of endoscopic stapes surgery were available for 259 patients and reported air bone gap (ABG) closure rates of 71.4% (0-10dB), 25.9% (11-20dB), 2.3% (21-30dB) and 0.4% (>30dB).

Conclusions:
Endoscopic stapes surgery has a similar complication profile to established microscopic approaches. The audiometric outcomes also mirror those reported for the traditional approach with ABG closure <20dB in 97.3% of cases. The data suggests that endoscopic stapes surgery represents a valid and safe alternative to those adept at the technique.