Comparison of Long-Term Microscopic and Endoscopic Audiologic Results After Total Ossicular Replacement Prosthesis Surgery

To compare short-term and long-term outcomes after transcanal endoscope-assisted with microscope-assisted ossiculoplasty using the Fisch titanium total prosthesis (FTTP). STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Pediatric (<18 yr of age) and adult patients undergoing ossiculoplasty with the FTTP between January 2016 and December 2019. INTERVENTION: Transcanal endoscope-assisted (n = 30) or microscope-assisted (n = 76) ossiculoplasty with the FTTP. In the microscopic group, 48 were performed through the ear canal and 28 by retroauricular approach. MAIN OUTCOME MEASURE: Short-term (3 mo) and long-term (average 20.2 mo) PTA(0.5-2kHz) air and bone conduction thresholds were evaluated. RESULTS: In total, 106 patients were included. Nine of 30 (30.0%) of endoscopic and 15 of 76 (19.7%) of microscopic patients were pediatric. Endoscopic preoperative air conduction PTA(0.5-2kHz) was 52.1 ± 15.8 dB and 52.2 ± 17.9 dB for the microscopic group (p > 0.05). Three months postoperative endoscopic air conduction PTA(0.5-2kHz) was 37.6 ± 17.4 dB (14.5 dB improvement) and 44.6 ± 19.9 dB (7.6 dB improvement) in the microscopic group (p > 0.05). Three months postoperative endoscopic PTA(0.5-2kHz) ABG was 26.8 ± 16.6 dB and 28.4 ± 14.7 dB in the microscopic group (p > 0.05). Latest follow-up endoscopic air conduction PTA(0.5-2kHz) audiogram (mean follow-up, 20.6 ± 10.4 mo) was 36.1 ± 18.2 dB (16.0 dB improvement) and 40.1 ± 16.8 dB (12.1 dB improvement) in the microscopic group (mean follow-up, 19.9 ± 10.3 mo)(p > 0.05). For endoscopic air conduction PTA(0.5-2kHz), between the 3 months and latest follow-up audiogram, 25.0% showed improvement, 50.0% remained stable, and 25.0% deteriorated. In the microscopic group, 26.7% improved, 46.6% remained stable, and 26.7% deteriorated (p > 0.05). CONCLUSION: Our study shows that hearing results with the Fisch titanium total prosthesis are in line with literature. Endoscope-assisted total ossiculoplasty proves to be a suitable technique with comparable results to the microscopic approach.