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Endoscopic ear surgery has gained popularity in recent years with wide panoramic visualisation of the operative field one of its key strengths. This article summarises the approach, set-up and outcomes of patients undergoing endoscopic stapes surgery. A key step during microscopic stapes surgery involves curetting of the scutum. The increased visibility of the middle ear allowed by the endoscopic technique involved less scutum removal, less manipulation of the chorda tympani nerve and subsequently up to 69% reduced risk of postoperative taste disturbance according to the authors. Pooled analyses of postoperative complications comparing microscopic and endoscopic techniques found no difference in terms of tympanic membrane perforation, dizziness, facial weakness and sensorineural hearing loss. Perhaps most importantly, no difference was found in terms of hearing outcomes either, when both techniques were compared. The authors shared their preferred technique for performing endoscopic stapes surgery with key elements involved using a 00 3mm diameter, 14cm length rigid endoscope with light intensity of 40 or less to reduce thermal injury. The authors preferred using the CO2 laser to perform the stapedotomy but advocate using a stapedotomy drill if there is significant footplate disease that could not be addressed with the laser. However, the authors did not describe their technique for inserting the prosthesis into the fenestration whilst using the endoscope. Of interest, this article also discussed several challenging scenarios that could be encountered such as revision surgery, perilymphatic gusher and narrow oval window niche with accompanying surgical videos. In general, perilymph gushers could be plugged with soft tissue grafts following insertion of the prosthesis, but these patients are usually associated with a worse outcome. In the case of a narrow oval window niche, the authors performed a limited drilling of the promontory to accommodate the prosthesis safely. 

Endoscopic stapes surgery: Pearls and pitfalls.
KL Yancey, NF Manzoor, A Rivas.
Otolaryngologic Clinics of North America
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Wai Sum Cho

Queens Medical Centre, Nottingham, UK.

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