Outcomes After Exoscopic Versus Microscopic Ossicular Chain Reconstruction.

OBJECTIVE

To analyze the outcomes of exoscopic versus microscopic ossicular chain reconstruction (OCR).

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary care otology-neurotology practice.

PATIENTS

Adult subjects with a diagnosis of ossicular discontinuity from 2018 to 2022.

INTERVENTIONS

Exoscopic or microscopic primary OCR (without mastoidectomy) with a partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP).

MAIN OUTCOME MEASURES

Audiometric outcomes at 3 months and 1 year postoperatively including bone and air pure tone averages (PTA), air-bone gap (ABG), change in ABG, speech reception threshold (SRT), and word recognition score (WRS). Secondary outcomes included operative time and complication rates of primary and delayed graft failure, tympanic membrane lateralization, prosthesis extrusion, cerebrospinal fluid leak, facial nerve injury, profound hearing loss, persistent tinnitus, and persistent vertigo.

RESULTS

Sixty ears underwent primary OCR and were subdivided based on prosthesis type (PORP and TORP) and surgical approach (exoscope vs microscope). Exoscopic OCR was performed on 30 ears (21 PORP, 9 TORP), and microscopic OCR was performed on 30 ears (19 PORP, 11 TORP). In the overall group (PORP + TORP) and in the PORP and TORP subgroups, there were no significant differences in 1) demographics, 2) intraoperative findings, and 3) audiometric outcomes of bone and air PTA, ABG, change in ABG, SRT, and WRS at 1 year postoperatively. Operative time was 64.7 and 59.6 minutes for the exoscopic and microscopic group, respectively ( p = 0.4, 95% CI [-16.4, 6.1], Cohen's D = 0.2).

CONCLUSIONS

Audiometric and surgical outcomes after exoscopic and microscopic OCR are comparable.