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

Holt, Justin1; Benuzillo, Jose2; Mosen, David2; Grosz, Anna3
1Department 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

Introduction: 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.
Results: 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)
Conclusion: 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.