TOTAL ENDOSCOPIC STAPES SURGERY. OUR TECHNIQUE AND EXPERIENCE OF 45 CASES

Objective: To assess the hearing results of transcanal endoscopic stapedotomy Study Design: Descriptive study. Place and Duration of Study: Pakistan Naval Ship Hafeez Islamabad Pakistan, from Jun 2016 to Jun 2020. Methodology: All patients with surgically confirmed otosclerosis were included in the study. All patients were operated with 0-degree 3mm, 14cm rigid endoscope under general anesthesia. Preoperative and post operative air bone gap was noted along with demographic data, middle ear anomalies (persistent stapedial artery, dehiscent facial nerve, anteriorly placed facial nerve, floating foot plate) and injury to chorda tympani. Postoperative air bone gap (A-B Gap) was documented 12 weeks after surgery. All patients were followed up for 6-12 months Results: Mean age of patients was, 37 years and standard deviation was 12.34 (range 27-52 years). Out of total 45 cases 13 were males (29%) and 32 females (71.%). Four (8.8%) patients had dehiscent facial canal and 1 (2.2%) patient had persistent stapedial artery. Average preoperative A-B gap was 35 db and Average Postoperative A-B Gap was 7 db. Chorda tympani was preserved in all cases. One patient (2.2%) complained of altered taste which resolved after 3 months. Four patients had Postoperative vertigo that lasted 2 days on average. Conclusion: Endoscopic trans canal Stapes surgery is scarless safe effective procedure demonstrable hearing benefits in all patients with minimum complications. The Technique is single handed and has steep learning curve.

Experience in endoscopic stapedotomy technique and its audiological outcome: a case series

Background Stapedotomy is being performed endoscopically for otosclerosis in Sudan since 2011 with increasing number of patients. This prospective hospital-based study from Nov 2016 to Nov 2020 states the clinic-demographic features of otosclerosis; it describes this surgical technique and hearing outcome following endoscopic stapedotomy. Results Total number included in the study was 91 patients. Females were 48, and males were 43 with a female to male ratio of 1.1:1. Age ranged from 19 years to 52 with a mean age of 30.6± 7 SD years. The main symptom was decreased hearing in all patients (100%); in 82 patients (90%), it was bilateral, followed by tinnitus in 80 patients (88%) while two patients (2.2%) had vertigo. Family history was stated by 2 patients (2.2%) only. Audiological assessment by pure tone audiogram (PTA) for each ear (total of 182) revealed that conductive hearing loss (CHL) is the commonest type of hearing loss in 148 ears (81.3%), mixed type in 30 ears (16.5%), while 4 ears (2.2%) were normal. Endoscopic stapedotomy was performed for 74 patients; this technique was safe; few complications were managed successfully: one gusher and one revision, with no facial nerve injury. Majority of complications happened during the first year. Mean air bone gap (ABG) gain was 23.3± 7.2 dB, air conduction (AC) gain was 18.3 ± 8 dB, and Carhart notch disappeared in 79.5%. Conclusions Endoscopic stapedotomy is a safe and effective procedure with a steep learning curve and a satisfactory hearing outcome. The air bone gap (ABG) gain was comparable to international studies.

Primary Endoscopic Stapes Surgery: A Comparison of Adipose Tissue and Gelfoam Seal

To compare the efficacy between the commonly used sealing materials, i.e., adipose tissue and the gelfoam in primary endoscopic stapedotomy. Lobular fat and gelfoam have been used in patients who underwent endoscopic stapedotomy between two groups, each containing 29 patients. The hearing outcomes and postoperative complications were compared at the end of 12 weeks between two groups. The ABG of ≤ 10 dB was achieved in 69% of cases in group A and 76% of cases in group B. There was a significant short-term (1 week) improvement in the Dizziness Handicap Inventory score (p = 00) with patients of adipose tissue seal compared to the gelfoam. Although the audiological outcomes were comparable between the two groups, the use of the adipose tissue can be a better alternative than gelfoam to control vertigo in the early postoperative period without causing any significant morbidity to the patient.

An overview of endoscopic stapedotomy in a tertiary care centre

<p class="abstract"><strong>Background:</strong> Stapedotomy is now one of the most popular and common surgeries done worldwide. Otosclerosis remains the most common single cause of conducting hearing loss in adult population. Females are more frequently affected than males with an approximate 2:1 ratio.</p><p class="abstract"><strong>Methods:</strong> This study consists of 30 patients who underwent stapedotomy for otosclerosis. This study was conducted at Dr Shankarrao Chavan Government Medical College, Nanded, during the period of 2 years (2017-2019). Patients were evaluated and operated. The various anatomical variations, diagnostic dilemmas, intraoperative complications, its management and follow-up were done systematically. </p><p class="abstract"><strong>Results:</strong> Age of patients included in this study ranged from 15 to 50 years. Youngest patient was a 17-year-old male. Age of presentation was most commonly seen in third decade of life. Male to female ratio was 1:2. The most common symptom was hard of hearing followed by tinnitus. In this study, 76.67% of the patient’s had bilateral disease. 66.66% of patients had hearing loss between 41-55 dB with mean pre-operative pure tone average was 51.16 dB. About 80% of patients had successful air bone closure between 0-10 dB after the surgery.</p><p class="abstract"><strong>Conclusions:</strong> Endoscopic stapedotomy seems a feasible and relatively safe surgical technique in limited case series. Cosmetically this procedure was more compliant by the patients however endoscopic stapedotomy requires a significant learning curve and an extreme expertise.</p>

Endoscopic Stapedotomy: A New Dimension to the Conventional Microscopic Procedure

Introduction Endoscopes are not only complementing microscopic ear surgery but are also establishing their independent role in recent years. Materials and Methods This observational study was conducted from February 2018 to February 2019. Thirteen patients with clinical and audio-tympanometric features suggestive of stapedial otosclerosis underwent unilateral endoscopic stapedotomy from February to July 2018. They were followed up for a minimum of 6 months, till February 2019. Zero degree naso-endoscopes were exclusively used. Details of the surgical technique, its usefulness and subjective drawbacks are described. Results Two patients with sequel of otitis media with effusion evident at surgery were excluded. With a female predilection, the average age of the subjects was 31 years (range: 17-56 years). Curettage of the posterosuperior wall was needed in 7 patients; significant canalplasty was performed in 2 of them where the endoscope was difficult to negotiate. The chorda tympani required mobilization in only 3 patients, including those requiring significant canalplasty. Per-operative complications included injury to the chorda, tearing of tympanomeatal flap, and instability of the long process of incus in 1 patient each. One patient was lost to follow up. Average pre-operative bone conduction was 10±5dB with an air-bone gap at 35±5dB. At 6 months follow up, air-bone gap of <10dB was achieved in 5 patients, and that at10-20dB in 4. One patient developed moderate sensorineural component. Otherwise, there was no significant complication at 6 months following surgery. Conclusion Endoscopic stapedotomy is a safe and effective approach towards stapes surgery, with better surgical field of view and minimal tissue trauma