SynthesisEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2026
Endoscopic versus microscopic stapedotomy: a comprehensive systematic review and meta-analysis incorporating all comparative evidence.
Synthesis in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMicroscopic stapedotomy (MSS) is the established surgical standard in stapes surgery. Endoscopic stapedotomy (ESS) has recently emerged as an alternative surgical approach, but a comprehensive comparison of its efficacy and safety, including evidence from all study designs, is lacking. This systematic review seeks to evaluate the efficacy and safety of ESS versus MSS.
methodsWe systematically searched four electronic databases until July 2025 to identify relevant studies. We included randomized controlled trials, non-randomized controlled studies, and observational studies comparing ESS versus MSS. The audiological outcomes were air-bone gap (ABG), air, and bone conduction. Other intraoperative and postoperative outcomes included scutum debridement, Chorda tympani nerve (CTN) manipulation, pain, and dysgeusia. A random-effects model was used to pool the risk ratio (RR), mean difference (MD), or standardized mean difference (SMD) with 95% confidence intervals (CI).
resultsThirty-six studies (2208 patients) were included. ESS showed a modest ABG improvement over MSS (MD = -1.30, 95% CI [-2.54, -0.05], p = 0.04), though not consistent across sensitivity and subgroup analyses. Bone conduction (MD = 0.57, 95% CI [-0.44, 1.57], p = 0.27), air conduction (MD = 0.07, 95% CI [-1.61, 1.76], p = 0.93), and operative time (MD = -3.81, 95% CI [-10.68, 3.07], p = 0.28) were comparable between both approaches. ESS significantly reduced scutum debridement (RR = 0.72, 95% CI [0.60, 0.88], p = 0.001), CTN manipulation (RR = 0.42, 95% CI [0.25, 0.71], p = 0.001), and dysgeusia (RR = 0.50, 95% CI [0.36, 0.70], p < 0.001).
conclusionESS provides comparable hearing outcomes to MSS while reducing chorda tympani nerve manipulation, dysgeusia, and the need for scutum removal. These findings support ESS as a viable alternative to MSS when performed by experienced surgeons.
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