Transcanal Endoscopic Stapedotomy – Safety Analysis

By June 7, 2019

Vaughan, Casey1; Jufas, Nicholas2, 3, 4; Patel, Nirmal2, 3, 4; Saxby, Alexander 1, 3, 4
1 Department of Otolaryngology, Royal Prince Alfred Hospital, Sydney, Australia
2 Department of Otolaryngolgoy, Royal North Shore Hospital, Sydney, Australia
3 Sydney Endoscopic Ear Surgery Research Group
4 University of Sydney, Australia

Transcanal endoscopic stapes surgery is a technically demanding procedure that is increasing in popularity.  Surgical outcomes have been demonstrated to be comparable to traditional microscopic techniques.  The surgical outcomes and complication rates for 60 patients undergoing stapes surgery performed by the Sydney Endoscopic Ear Surgery Research Group are presented.

A retrospective case review of patients undergoing endoscopic stapes surgery performed by 3 surgeons between February 2015 and January 2019 was carried out.  Patients were identified, and assessed for demographics, functional results and post- operative complications.

In total, 60 patients underwent endoscopic assisted stapedotomy. 88% were laser assisted The average age was 49 (age range 22-75, 28 females; 32 males). All operations were performed under a general anaesthetic, 34 operations were performed entirely endoscopically (class 3) and the remaining operations were performed utilising the endoscope for more than 50% of the dissection (class 2b). 100% of cases saw improvement in the 4 frequency air bone gap (ABG) (0.5, 1, 2, 4 kHz). The average improvement was 26 dB (range 6-61dB). ABG closure rates of 82.7%  for 0-10 dB, 15.6% 11-20 dB, 1.7% 21-30 dB were achieved. Post-operative complications were infrequent and self-limiting.  Five patients experienced temporary dysgeusia, four patients developed short lived vertigo and two patients experienced mild tinnitus still present at six month follow up. There were no cases of sensorineural hearing loss or anacusis.

Transcanal endoscopic stapes surgery represents a safe alternative to traditional microscopic techniques, with over 98% achieving an ABG closure of <20 dB.