DOI: 10.1097/ms9.0000000000005239 ISSN: 2049-0801

Endoscopic stapes surgery for otosclerosis: clinical, radiological, and audiological outcomes in a retrospective series of 40 patients

Saad Bouchlarhem, Achraf Amine Sbai, Drissia Benfadil, Azeddine Lachkar
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Background:

Otosclerosis is a primary osteodystrophy of the otic capsule, characterized by abnormal bone remodeling, leading to stapes fixation and progressive conductive or mixed hearing loss. Although microscopic stapes surgery remains the historical standard, endoscopic ear surgery has gained increasing interest due to improved visualization of middle ear anatomy and its minimally invasive transcanal approach. This study aimed to evaluate the clinical, radiological, and audiological outcomes of exclusive endoscopic stapes surgery in a retrospective cohort of patients with otosclerosis.

Methods:

We conducted a retrospective observational cohort study including 40 patients who underwent exclusive transcanal endoscopic stapedotomy for otosclerosis at the Department of Otorhinolaryngology, Mohammed VI University Hospital, Oujda, between January 2023 and December 2025. Postoperative pure-tone audiometry was systematically performed 3 months after surgery (±2 weeks). Patients without audiometric evaluation at this predefined endpoint were excluded. Air-conduction (AC) and bone-conduction (BC) pure-tone averages (0.5–1–2–4 kHz) were recorded pre- and postoperatively. The air–bone gap (ABG) was calculated as the difference between AC-PTA and BC-PTA. Pre- and postoperative outcomes were compared using paired statistical analysis.

Results:

Forty patients (mean age 34 years) were included. The mean preoperative ABG was 32 ± 6 dB and decreased to 9 ± 4 dB postoperatively, corresponding to a mean improvement (ΔABG) of 23 dB ( P < 0.001). The majority of patients achieved functional ABG closure (≤10 dB). Mean AC-PTA improved significantly, while BC-PTA remained stable, with no cases of postoperative sensorineural hearing loss defined as BC deterioration ≥10 dB. Endoscopic stapedotomy was successfully completed in all cases. Complications were limited to transient minor events, with no facial nerve dysfunction or persistent vertigo.

Conclusion:

Exclusive transcanal endoscopic stapes surgery is a safe, reproducible, and effective technique for the management of otosclerosis. The endoscopic approach provides optimal visualization of middle ear anatomy and yields favorable functional outcomes with low morbidity, supporting its role as a reliable alternative to conventional microscopic techniques in experienced centers.

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