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Endoscopic Stapes Surgery: Our Experience

Presenting Author: Rhona Sproat

Published online by Cambridge University Press:  03 June 2016

Rhona Sproat ,
Constantina Yiannakis  and
Arunachalam Iyer
Rhona Sproat
Affiliation:
NHS Lanarkshire
Constantina Yiannakis
Affiliation:
NHS Lanarkshire
Arunachalam Iyer
Affiliation:
NHS Lanarkshire
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Abstract

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Learning Objectives: To report our experience with the use of endoscopes in stapes surgery in terms of complication rates and hearing outcomes.

Introduction: Endoscopic ear surgery is a rapidly developing area in otology. The endoscope can provide a unique view of middle ear anatomy and is being utilised to facilitate ever more surgical procedures. We aim to report our experience with use of the endoscope in stapedectomy.

Methods: Data was collected prospectively for all stapectomy operations carried out in NHS Lanarkshire by a single surgeon from August 2009 to December 2015, using the Common Otology Audit, a UK wide data collection tool. Outcome measures were pure tone audiometry pre- and post-operatively at 0 and 3 months; and complication rates at 3 month follow up.

Results: 83 operations were carried out for otosclerosis with stapes fixation during this time period. 78 of these were primary operations, and 5 were revision procedures. 27 of these were carried out endoscopically or endoscopic-assisted, and 56 were performed using an operating microscope. Average total pre-operative air-bone gap was 29 dBHL; 28 dBHL for endoscopic operations; and 29 dBHL for open operations. 70 patients were followed up in clinic at 3 months. Two were lost to follow-up from the endoscopic group and 11 from the open group. Average post-operative air-bone gap was 7.9 dBHL in the open group and 7.6 dBHL in the endoscopic group. 84% of patients achieved reduction in air-bone gap to less than 10dBHL in the open group and 88% in the endsocopic group. 100% of both groups achieved less than 20 dBHL. No patients had a facial nerve palsy, vertigo or complained of taste dysfunction. One patient complained of tinnitus at 3 months from the endoscopic ear surgery group.

Conclusions: Our results demonstrate that the endoscopic approach to ear surgery has comparable outcomes to microscopic approaches, both in respect to our own unit, and to published literature, in terms of hearing gain and complication rates. Our experience suggests that endoscopic approach to ear surgery is safe and effective.