Endoscopic Versus Microscopic Stapedotomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Objective: To compare the safety and efficacy of endoscopic versus microscopic stapedotomy in patients with otosclerosis.

Data Sources: PubMed, Embase, Web of Science, Scopus, Google Scholar, and CENTRAL.

Review Methods: Eligible randomized controlled trials (RCTs) were assessed for bias using Cochrane's instrument. The specific outcomes included the mean duration of surgery, the mean gain in air-bone gap (ABG), and the rates of chorda tympani nerve (CTN) injury, CTN manipulation, facial nerve (FN) injury, tympanic membrane (TM) perforation, dysgeusia, dizziness, and pain score. Continuous data were analyzed using mean difference (MD) or standardized mean difference (SMD), and dichotomous data with risk ratio (RR), with 95% confidence intervals (CIs).

Results: Eleven RCTs with 515 patients were analyzed. There was no significant difference between both groups in the mean duration of surgery (MD = -10.42, 95% CI [-26.26, 5.43]), mean gain in ABG (MD = 1.04, 95% CI [-0.48, 2.57]), CTN injury (RR = 0.46, 95% CI [0.20, 1.04]), FN injury (RR = 1.00, 95% CI [0.11, 9.27]), TM perforation (RR = 0.99, 95% CI [0.23, 4.25]), and dizziness (RR = 0.79, 95% CI [0.41, 1.53]). However, endoscopic stapedotomy significantly reduced the need for CTN manipulation (RR = 0.58, 95% CI [0.35, 0.96]), dysgeusia (RR = 0.33, 95% CI [0.19, 0.57]), and pain score (SMD = -1.59, 95% CI [-2.22, -0.97]).

Conclusion: Endoscopic stapedotomy significantly reduces dysgeusia, CTN manipulation, and pain compared to microscopic stapedotomy, with similar surgery durations, audiometric gains, and comparable risks of CTN injury, TM perforation, FN injury, and dizziness.