Stapedotomy in Otosclerosis: A GRADE-Guided Systematic Review and Meta-analysis of Endoscopy vs. Microscopy.

Objective: A definitive comparison between endoscopic and microscopic techniques in stapes surgery for otosclerosis patients regarding safety and efficacy, we exclusively included randomized controlled trials (RCTs) and applied the GRADE methodology to assess the certainty of the evidence in our conclusions.

Databases reviewed: A search across PubMed, Web of Science, Scopus, and Cochrane Library was conducted from inception to December 2024. We included only RCTs that compared both techniques of stapes surgery in otosclerosis patients.

Methods: Primary outcomes were change in air-bone gap (ABG), postoperative ABG, chorda tympani nerve (CTN) manipulation/handling, CTN injury, and postoperative dysgeusia. Secondary outcomes focused on operation time, visibility of incudostapedial complex before suprastructure removal, scutum curettage, postoperative pain and vertigo, hearing improvement, facial nerve injury, tympanic membrane perforation, gusher phenomenon, and tympanomeatal flap tear.

Results: Eleven RCTs, with a total of 532 patients, met the inclusion criteria. For mean change in ABG (1.35 [95% CI (-0.22, 2.91)], p = 0.09), postoperative ABG (-0.51 [95% CI (-1.16, 0.14)], p = 0.12), CTN injury, operative time, hearing improvement, and postoperative vertigo, no significant differences were found between both approaches. However, endoscopy was significantly favored over microscopy regarding CTN manipulation RR = 0.63 [95% CI (0.45, 0.88), p < 0.01], postoperative dysgeusia RR = 0.24 [95% CI (0.14, 0.43), p < 0.01], visibility of Incudostapedial complex, scutum curettage, and postoperative pain.

Conclusion: Similar auditory results following both techniques of stapes surgery in otosclerosis patients. However, endoscopy seems superior regarding CTN manipulation, scutum curettage, postoperative dysgeusia, and pain.