Otosclerosis Surgery : What More With The Endoscope?

By June 7, 2019

Chelly, Hassan1
1 Departement of Otology, ENT AL FARABI Clinic, Casablanca, Morocco.

When using microscope, otosclerosis surgical procedure is well described in academic medical books and reviews.
Is it the same when using the endoscope ? Surely not !
In this retrospective study, 80 cases of otosclerosis were reviewed. Surgical finding according to the surgical steps are analysed.
The most surgical procedure was platinotomy (76 cases-95%) and the platinectomy is reserved to the technical issues when openning
the footplate. All cases concern 0,4 mm diameter silicone piston and related to first hand surgery in most cases (77 cases – 96%). We discuss the need to make a bone notch when exposing the oval window. In fact, the endoscope allows to go close to the structure so that, in most cases, we perform minimal surgical steps. When it comes to the positionning of the piston, we think that the control of the tip of the piston is better when its handle is placed anteriorly from the long process of the incus. Finally, in case of revision surgery, specially in cases of necrosis of the long process of the incus, the access to the maleus allows to use it to clip the piston and control the mobility of the ossicular chain.
Endoscopic otosclerosis surgery is more difficult than microscopic. Long learning curve is necessary to use that special tool and perform safe surgery.
However, the endoscope allows a perfect panoramic view of the footplate and the surgical steps is well controlled.