Discussion
perforations, taste disturbance, vertigo, subluxation, hearing outcome and post-operative complications, otosclerosis, Injury of the chorda tympani typically
SENSORINEURAL HEARING LOSS, NEURAL HEARING LOSS, COMPLICATION, OTOSCLEROSIS, POST-OPERATIVE PROBLEMS, HEARING LOSS, COMPLICATIONS
Surgical techniques for treatment of otosclerosis have been improved, updated, or adjusted over time to lower intraoperative and post-operative problems and boost overall effectiveness [Not only the order of surgical steps was debatable but also the surgical tool, whether to use the microscope or the endoscope. Different studies compared microscopic with endoscopic stapedotomy. Although hearing outcome and post-operative complications were comparable, the endoscope gives a very important advantage which is the excellent visualization [The utilization of endoscope in stapes surgery has many advantages. The wide angle of view offered by endoscope allows better exposure of both stapes and its footplate. In addition, it facilitates detection of any anatomical variations or pathological changes. Moreover, it allows confirmation of the proper insertion of the prosthesis [Throughout the literatures, many studies were conducted to compare classic and reversal stapedotomies. All these studies were performed using the microscope. To our knowledge, our current study is the first in the literatures that compared classic and reversal stapedotomies using the endoscope.In our study, statistically significant reductions in post-operative AC thresholds, ABGs and SRTs were obtained in both groups indicating that both techniques were effective in management of associated hearing loss. When both groups were compared, no statistically significant differences in post-operative AC thresholds, ABGs or SRTs were found. Moreover, closure of the ABG within 10 dB was attained in 76.67% and 80% of cases in groups 1 and 2 respectively, with statistically non- significant difference. All these findings suggested that endoscopic classic and reversal techniques were comparable as regards hearing outcome. Such finding was in agreement with the previously published studies [Sensorineural hearing loss is relatively uncommon complication [During stapes surgery, small perforations of the tympanic membrane are usually closed with fascial graft at the end of the surgery with excellent result. Injury of the chorda tympani typically occurs during curettage or during its mobilization to expose the oval window. Such complication was estimated to occur in about 3% of cases in the literatures [In our study, no sensory neural hearing loss was encountered in any of the cases of both groups. In addition, no statistically significant differences were reported between the two groups as regards post-operative vertigo and taste disturbance. All these findings were comparable to the previously published studies [Floating footplate is one of the major complications that may be encountered during stapes surgery. In this condition, the footplate is accidently mobilized and may be pushed into the vestibule. Such complication may occur when the footplate is pushed too strong with manual perforator or even with microdrill. To avoid this complication, perforation should be done before removal of the stapes superstructure (as in reversal stapedotomy). Such support provided by the stapes superstructure will prevent footplate mobilization during perforation. Another method of prevention of such complication was the utilization of COIncus subluxation was another complication that may be encountered during stapes surgery. It was reported to occur if removal of stapes superstructure was done before insertion of the prosthesis. Thus, it is also unsurprising to encounter such complication in classic stapedotomy than in reversal type [Since this study; to our knowledge; is the first randomized controlled trial that compared classic and reversal stapedotomy techniques endoscopically, the authors are encouraging further studies with relatively larger sample size.