Objective: To assess all available data regarding the comparative success rates of endoscopic and microscopic stapes surgery.
Methods: MEDLINE, the Cochrane Library and Web of Science databases as well as other sources were searched by two independent reviewers. Controlled studies comparing endoscopic and microscopic stapedotomy in patients with otosclerosis or congenital stapedial fixation were included. Achievement of a postoperative air-bone gap ≤ 10 decibel was the primary outcome. Secondary outcomes were postoperative dysgeusia, scutum drilling and operation time. In case of homogenous, processable data (I2 < 60%) a meta-analysis was performed. Odds ratio (OR) and Chi-square test were used to compare the two methods.
Results: Seven studies met the inclusion criteria. The OR analysis showed no significant differences between the two methods (OR 1.41, 95%CI [0.84, 2.38]), but goodness-of-fit analysis showed a correlation of endoscopic stapedotomy with normal hearing restoration (p = 0.00). Dysgeusia and scutum drilling took place significantly less often in the endoscopy group (OR 0.31, 95%CI [0.14, 0.69], p = 0.00 and OR 0.01, 95%CI [0.00, 0.07], p = 0.00 respectively).
Conclusion: As of yet, endoscopic surgery does not seem to confer benefit on audiological improvement comparing to conventional microscopic, however, it leads to less scutum drilling and fewer postoperative dysgeusia cases. High-quality, large-sample studies need to be performed in the future.
Keywords: Congenital stapedial fixation; Endoscopy; Microscopy; Otosclerosis; Stapes surgery.