Although the endoscopic approach to ear surgery has become more common in clinical practice, the debate about its role versus the traditional microscopic approach continues in many ENT units. This meta-analysis from the Mount Sinai ENT department in New York looked at the available evidence, most of which has been published in the last 10 years, to draw conclusions about clinical outcomes specifically after tympanoplasty and stapedectomy procedures. Sixteen studies reached inclusion criteria for tympanoplasty, with over 600 ears in both the endoscopic and microscopic surgery groups. Ten were controlled trials and six retrospective cohort studies.

Overall, there was no difference between groups in graft failure rate (including subgroup analysis of graft type) or audiological outcomes, although there was acknowledged heterogeneity in reporting of audiology results. There were significantly lower rates of canalplasty in the endoscopic group (0% versus 18%), shorter operative time and better patient-reported cosmetic scores postoperatively.

Stapedectomy studies reaching inclusion criteria (five studies) included over 100 ears in each group, with two controlled trials and three retrospective cohort studies. There were lower rates of chorda tympani injury in the endoscopic group and reduced postoperative pain. Similar to the tympanoplasty studies, there was no statistical difference in audiological outcomes. In the stapedectomy group there was no difference either in postoperative dizziness or in duration of operative time using either technique. A meta-analysis such as this has significant inherent difficulties of bias and heterogeneity of technique and outcome reporting, which the authors do clarify. In particular, they draw attention to the well-documented learning curve of the endoscopic technique. It is still a useful overview of the pros and cons for those who are considering the safety and efficacy of endoscopic ear surgery.

Endoscopic Versus Microscopic Middle Ear Surgery: A Meta-analysis of Outcomes Following Tympanoplasty and Stapes Surgery.
Manna S, Kaul VF, Gray ML, Wanna GB.
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Aileen Lambert

Great Ormond Street Hospital, London, UK.

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