People born with congenital ossicular malformation often need surgery to fix their hearing. This review looked at two common ways to operate: endoscopic ear surgery and microscopic ear surgery. The team analyzed data from 304 patients with 320 ears. They wanted to know which method worked better and was safer. The results show that endoscopic surgery took significantly less time to perform. On average, it was about 10 minutes shorter than the microscopic approach. This shorter time means less time under anesthesia for the patient. The review also found that endoscopic surgery was linked to a lower rate of complications overall. More importantly, serious problems like nerve injury or hearing loss were seen in the microscopic group but not in the endoscopic group. These serious issues were not reported for the endoscopic patients. The review did not find a big difference in how much hearing improved or how many people reached a specific hearing goal. Both methods achieved similar results for hearing levels. The study suggests endoscopic surgery could be a reasonable choice for doctors to consider.
Endoscopic ear surgery reduces operative time and complications versus microscopic surgery for congenital ossicular malformationEndoscopic surgery cuts time and serious risks for congenital ear malformations
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Key Takeaway
Consider EES as a reasonable alternative to MES for congenital ossicular malformation.
This meta-analysis evaluates endoscopic ear surgery (EES) versus microscopic ear surgery (MES) in patients with congenital ossicular malformation. The analysis included 304 patients involving 320 ears. The primary focus was on operative efficiency and postoperative hearing outcomes.
Regarding operative time, EES was associated with significantly shorter duration compared with MES. The mean difference was -10.38 min with a 95% CI of -14.05 to -6.72 min and a p-value less than 0.001. For postoperative air-bone gap improvement, EES showed a greater effect size of 4.22 dB HL with a 95% CI of 0.05 to 8.39 dB HL and a p-value of 0.048. However, no statistically significant differences were found for preoperative ABG, postoperative ABG, or the proportion of patients achieving a postoperative ABG less than or equal to 20 dB HL.
Safety analysis indicated a lower complication rate with EES. Serious complications, including chorda tympani nerve injury and sensorineural hearing loss, were reported in the MES group but were not observed in the EES group. The authors conclude that EES may serve as a reasonable alternative to conventional MES for this condition.
What this means for you:
Endoscopic surgery was faster and linked to fewer serious complications than microscopic surgery. View Original Abstract ↓
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.
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