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

IF 2.6 3区医学 Q1 OTORHINOLARYNGOLOGY Otolaryngology- Head and Neck Surgery Pub Date : 2025-01-03 DOI:10.1002/ohn.1109

Ebraheem Albazee, Hamad Alajmi, Ali Aldoukhi, Abeer Waleed Alali

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Abstract

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.

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内镜下与显微镜下镫骨切除术：随机对照试验的系统回顾和荟萃分析。

目的：比较内镜下与镜下镫骨切除术治疗耳硬化症的安全性和有效性。数据来源：PubMed， Embase, Web of Science, Scopus，谷歌Scholar和CENTRAL。评价方法：采用Cochrane工具评估符合条件的随机对照试验（RCTs）的偏倚。具体结果包括平均手术时间、平均气骨间隙（ABG）增加、鼓膜索神经（CTN）损伤率、CTN操作率、面神经（FN）损伤率、鼓膜（TM）穿孔率、发音障碍、头晕和疼痛评分。连续资料采用均差（MD）或标准化均差（SMD）进行分析，二分类资料采用风险比（RR）， 95%可信区间（ci）。结果：共分析11项随机对照试验515例患者。两组患者的平均手术时间（MD = -10.42, 95% CI[-26.26, 5.43]）、ABG平均增加（MD = 1.04, 95% CI[-0.48, 2.57]）、CTN损伤（RR = 0.46, 95% CI[0.20, 1.04]）、FN损伤（RR = 1.00, 95% CI[0.11, 9.27]）、TM穿孔（RR = 0.99, 95% CI[0.23, 4.25]）和头晕（RR = 0.79, 95% CI[0.41, 1.53]）均无显著差异。然而，内镜下镫骨切开术显著减少CTN操作（RR = 0.58, 95% CI[0.35, 0.96]）、发音障碍（RR = 0.33, 95% CI[0.19, 0.57]）和疼痛评分（SMD = -1.59, 95% CI[-2.22, -0.97]）的需要。结论：内镜下镫骨切开术与镜下镫骨切开术相比，可显著减少发音困难、CTN操作和疼痛，手术时间、听力增益相似，CTN损伤、TM穿孔、FN损伤和头晕的风险相当。

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来源期刊

Otolaryngology- Head and Neck Surgery 医学-耳鼻喉科学

CiteScore

6.70

自引率

2.90%

发文量

250

审稿时长

2-4 weeks

期刊介绍： Otolaryngology–Head and Neck Surgery (OTO-HNS) is the official peer-reviewed publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation. The mission of Otolaryngology–Head and Neck Surgery is to publish contemporary, ethical, clinically relevant information in otolaryngology, head and neck surgery (ear, nose, throat, head, and neck disorders) that can be used by otolaryngologists, clinicians, scientists, and specialists to improve patient care and public health.