The Clinic Research Of Ear Endoscope Applied In Otosclerosis Artificial Stapes Surgery

Otosclerosis is a disease of unknown etiology.The dense bone of the inner ear bony labyrinth undergoes repeated focal resorption and is replaced by spongy new bone rich in blood vessels and cells.Then the blood vessels are reduced,the bone is deposited,and the bone sclerosis is formed.Most patients have clinical symptoms due to stapes fixation caused by sclerosing lesions invading the vestibular window,which are manifested as slow progressive hearing loss in both ears and low-pitched tinnitus.Some patients may be accompanied with vertigo.It is one of the common clinical deaf diseases.The stapedotomy with small hole under the microscope and artificial stapes implantation is the mainstream operation to treat the stapes-type otosclerosis in current.In recent years,there have been more and more reports about the application of endoscopic technology in middle ear surgery,such as tympanic membrane repair,ossicular chain reconstruction,and middle ear cholesteatoma resection.Compared with microscope surgery,auricular endoscopic surgery has better illumination,wide-angle,close observation and clear vision etc.But there are also some safety hazards such as narrow operation space,inconvenience of one-handed operation,and flat viewing angle.Can otoscope technology be safely and effectively applied to stapes surgery?How effective is it? There are not many domestic research reports,for this reason,we have carried out this research.This study retrospectively analyzed the clinical datas of 21 patients with otosclerosis who underwent endoscopic stapes implantation in our hospital from January 2017 to December 2019.These 21 patients were all operated under general anesthesia with 0° and 30° endoscopes with a diameter of 3 mm and a length of 14 cm.During the operation,a curette was used to remove part of the scutellum bone varying degrees.In 5 patients,laser was used to perforate the stapes floor,but 2 of them failed and successfully perforated with a triangular needle.In one patient,it was difficult to place the prosthesis during the operation,and we immediately switched to the two-handed operation under the microscope to place it smoothly.The study found that at 3 months after the operation,compared with before the operation,the average bone conduction hearing threshold of 21 patients had no significant difference(P>0.05).The average air conduction hearing threshold(60.9±9.3d B before operation vs 36.1±9.9d B after operation)and air-bone gap(ABG)(preoperative 31.1±6.1d B vs postoperative 9.7±4.9d B)was significantly reduced and narrowed(P<0.05),and the ABG of 21 patients(100%)was reduced to within 20 d B,and 16 cases(76.2%)were within 10 d B after the operation.No serious complications such as sensorineural hearing loss and facial paralysis occurred in21 patients.The treatment of otosclerosis with artificial stapes implantation under otoscope is minimally invasive,clear of vision,safe and effective.However,the surgeon must have proficient experience and skills in traditional stapes surgery under microscope and other middle ear surgery under endoscopy.When one-handed operation is inconvenient during the operation,we should switch to two-handed operation under the microscope in time.