Endoscopic versus microscopic stapes surgery outcomes: A meta-analysis and systematic review

Alexandros Koukkoullis, István Tóth, Noémi Gede, Zsolt Szakács, Péter Hegyi, Gábor Varga, István Pap, Kinga Harmat, Adrienn Németh, István Szanyi, László Lujber, Imre Gerlinger, Péter Révész

Research output: Contribution to journalReview article


Objective: Compare intraoperative and postoperative outcomes of endoscopic and microscopic stapes surgery to provide objective evidence on whether the former is a better alternative than the latter. Methods: We performed a systematic review and meta-analysis for studies that compared endoscopic stapes surgery with microscopic stapes surgery. Only studies that met predetermined criteria were selected and assessed for bias and quality. Primary outcomes were postoperative air–bone gap (ABG) and chorda tympani nerve injury. Secondary outcomes were average operating time, tympanic membrane (TM) perforation, and postoperative taste disturbance, pain, and dizziness. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous outcomes and weighted mean difference (WMD) with 95% CI for continuous outcomes. A confidence interval starting above 1.0 was considered as statistically significant. I2 and χ2 tests were used to quantify statistical heterogeneity. We used funnel plots to look for publication bias and performed a sensitivity analysis. Results: Six nonrandomized cohort studies were eligible. The primary outcomes were ABG < 10 dB: OR = 1.80 (95% CI: 0.96 to 3.38), ABG = 11 dB to 20 dB: OR = 1.49 (95% CI: 0.76 to 2.93), ABG > 20 dB: OR = 2.51 (95% CI: 0.77 to 8.22), and chorda tympani injury: OR = 3.51 (95% CI: 1.55 to 7.93). Secondary outcomes were taste: OR = 2.36 (95% CI: 1.01 to 5.51), average operation time: WMD = 0.14 (95% CI: −11.69 to 11.98), TM perforation: OR = 1.70 (95% CI: 0.44 to 6.58); pain: OR = 0.84 (95% CI: 0.36 to 1.96), and dizziness: OR = 2.15 (95% CI: 0.94 to 4.89). Conclusions: Endoscopic stapes surgery is a valid alternative to the microscope. Level of Evidence: 2a. Laryngoscope, 2019.

Original languageEnglish
Publication statusAccepted/In press - Jan 1 2019


  • Endoscopic
  • microscopic
  • otosclerosis
  • stapedectomy
  • stapedotomy

ASJC Scopus subject areas

  • Otorhinolaryngology

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    Koukkoullis, A., Tóth, I., Gede, N., Szakács, Z., Hegyi, P., Varga, G., Pap, I., Harmat, K., Németh, A., Szanyi, I., Lujber, L., Gerlinger, I., & Révész, P. (Accepted/In press). Endoscopic versus microscopic stapes surgery outcomes: A meta-analysis and systematic review. Laryngoscope. https://doi.org/10.1002/lary.28353