Endoscopic versus microscopic approach in stapes surgery: are operative times and learning curve important for making the choice?

OBJECTIVE: Analyze the surgical outcomes of endoscopic stapes surgery, comparing the results with a conventional stapes surgery under microscopic approach. Estimate the operation type of each surgical approach and show a learning curve of endoscopic stapes surgery. STUDY DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENTS: Twenty patients who underwent endoscopic stapedotomy for otosclerosis and 20 patients who underwent microscopic stapedotomy for otosclerosis. INTERVENTIONS: Endoscopic and microscopic stapes surgery. MAIN OUTCOME MEASURES: Operating time, preoperative and postoperative hearing, intraoperative findings, postoperative complications, and postoperative pain. RESULTS: The group of patients who underwent endoscopic stapes surgery showed a mean operative time calculated to be 45.0 min. The group of patients treated by microscopic approach had an estimated mean value of 36.5 min. Statistical difference was evident (p value = 0.01). The average duration of endoscopic surgery varied as the surgeon gained experience. There were no statistical differences between the average surgical times for the endoscopic and microscopic approaches (p >0.05) in the last 4-month period of surgery. Through the endoscopic approach the percentage of ears with a postoperative air-bone gap ≤20 dB was 95%. No difference from the percentage of the microscopic group (90%) (p >0.05) was reported. No difference regarding the incidence of intraoperative findings and postoperative complications between endoscopic and microscopic approaches was found. CONCLUSION: Audiological outcomes achieved by endoscopic surgery are similar to the results obtained through a microscopic approach. Longer initial operative times and a learning curve are the principal grounds that might discourage most ear-surgeons from commencing endoscopic stapes surgery.