Endoscopic ear surgery reduces operative time and complications versus microscopic surgery for congenital ossicular malformation

To compare the clinical efficacy of endoscopic ear surgery (EES) and microscopic ear surgery (MES) in the treatment of congenital ossicular malformation. PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), and Wanfang databases were systematically searched from inception to June 20, 2025, to identify comparative studies of EES versus MES in patients with congenital ossicular malformation. The evaluated outcomes included postoperative air-bone gap (ABG), ABG improvement, the proportion of patients achieving a postoperative ABG≤20 decibels hearing level (dB HL), operative time, and surgical complications. A total of seven retrospective cohort studies involving 304 patients (320 ears, age range: 3-62 years) were included. Of these, 148 ears underwent EES and 172 ears underwent MES. Qualitative analysis indicated that EES had a lower complication rate. Serious complications reported in the MES group, including chorda tympani nerve injury and sensorineural hearing loss, were not observed in the EES group. Quantitative analysis demonstrated that EES was associated with significantly shorter operative time (=-10.38 min, 95%:-14.05 to -6.72 min, <0.001) and greater postoperative ABG improvement (=4.22 dB HL, 95%: 0.05 to 8.39 dB HL, 0.048) compared with MES. No statistically significant differences were found between the two groups in preoperative ABG (=-0.96 dB HL, 95%:-3.09 to 1.17 dB HL, 0.379), postoperative ABG (=-1.95 dB HL, 95%:-3.98 to 0.08 dB HL, =0.059), or the proportion achieving postoperative ABG≤20 dB HL [EES, 80.0% (64/80) vs MES, 75.0% (75/100), =1.04, 95%: 0.89 to 1.22, 0.617]. For patients with congenital ossicular malformation, EES is associated with shorter operative time and greater postoperative ABG improvement than MES. EES may serve as a reasonable alternative to conventional MES.