Pediatric Endoscopic Ossiculoplasty Following Surgery for Chronic Ear Disease

Objective Rigid endoscopes can improve visualization of the tympanic space compared to traditional microscopic techniques. This study investigates whether use of transcanal endoscopic ossiculoplasty influences audiologic outcomes compared to microscopic ossiculoplasty following chronic ear surgery in children. Study Design Comparative cohort study at two tertiary care centers. Methods Retrospective review of pediatric chronic ear cases where ossiculoplasty was performed from February 2009 to March 2018. Results We identified 100 ears that underwent endoscopic ossiculoplasty and 100 ears that underwent microscopic ossiculoplasty. The mean age was 11 years (range, 4-18 years) with 63% males. There were no significant differences in these parameters between the two groups. Subjects underwent either primary ossiculoplasty or ossiculoplasty during second-look procedures. There was no significant difference in air conduction pure tone average (PTA) after microscopic cases compared to endoscopic cases (-12.5 dB vs. -10.5 dB, P = .40). These results were independent of prosthesis type. Microscopic ossiculoplasty was significantly more likely to use a post-auricular approach (P = .0001). There was no difference in complication rate between the two groups. The malleus was more likely to be absent or removed prior to endoscopic ossiculoplasty (P = .0004) with no significant difference in the change in PTA between groups. Conclusions Transcanal endoscopic ossiculoplasty was found to have equivalent audiometric outcomes with significantly fewer post-auricular approaches and no increase in complications compared to microscopic ossiculoplasty. While the malleus was more likely to be absent in endoscopic cases, this did not appear to influence the change in PTA. Level of Evidence 4 Laryngoscope, 2020