Pediatric Stapes Surgery: Hearing and Surgical Outcomes in Endoscopic vs. Microscopic Approaches

By June 7, 2019

Tolisano, Anthony M1; Fontenot, Miles R2; Nassiri, Ashley M3; Hunter, Jacob B1; Kutz, J. Walter1; Rivas, Alejandro3; Isaacson, Brandon1
1 Department of Otolaryngology – Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA;
2 Medical Scientist Training Program, University of Texas Southwestern Medical Center, Dallas, TX, USA;
3 Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA.

To compare endoscopic and microscopic pediatric stapes surgery.

Study Design: Case series with chart review.
Setting: Two academic otology practices.
Patients: Consecutive children (<18 years) with surgically confirmed stapes fixation.
Intervention: Endoscopic and microscopic stapes surgery.

Main Outcome Measure: Closure of the air-bone gap (ABG) to ≤20 dB.

Twenty-two endoscopic (17 stapedectomy, 4 stapedotomy, and 1 stapes mobilization) and 52 microscopic (30 stapedectomy, 19 stapedotomy, and 3 stapes mobilization) surgeries were performed. Patient demographics, history of prior ipsilateral middle ear surgery, and revision stapes surgery status were similar. The most common diagnosis for the endoscopic group and microscopic group were congenital stapes footplate fixation (45.5%) and juvenile otosclerosis (46.2%), respectively. Preoperative ABG in the endoscopic (37.7 dB) and microscopic (32.8 dB) groups (p=0.170) were similar. There were no major complications, including facial nerve injury or anacusis, in the endoscopic group. Postoperative sensorineural hearing loss (>15dB) did not occur in any patients in the endoscopic group but was present in two patients in the microscopic group (p=0.546). Improvement in pure-tone average (25.9 dB vs. 18.5 dB, p=0.382) and ABG (21.7 dB vs. 14.7 dB, p=0.181) were similar, and postoperatively, the median ABG was 11.3 dB and 15.0 dB for endoscopic and microscopic cases (p=0.703), respectively. ABG closure to ≤20 dB (72.7% vs. 65.2%, p=0.591) were also similar.

Pediatric endoscopic stapes surgery is safe and hearing outcomes are similar to the microscopic approach when performed by experienced endoscopic ear surgeons.