Endoscopic Reverse Stapedotomy for Otosclerosis: A Technical Video Report

Endoscopic stapedotomy offers a panoramic transcanal view of middle-ear structures while minimizing canal trauma. Reverse stapedotomy, in which the footplate fenestration precedes the removal of the stapes superstructure, may improve footplate stability and procedural safety. The use of CT-based three-dimensional (3D) virtual endoscopy for surgical planning in otosclerosis remains uncommon. We present the case of a 35-year-old female with bilateral otosclerosis (stage 1B on high-resolution CT) and a 35 dB air-bone gap in the poorer-hearing ear. Preoperative CT-based 3D virtual endoscopy simulated the surgical view, revealing that a Rosen notch would be needed to visualize the stapes suprastructure. Endoscopic reverse stapedotomy was performed using a manual microtrephine for a 0.6 mm platinotomy, followed by superstructure removal and super-titanium piston placement. At six weeks, the tympanic membrane was intact, the prosthesis stable, and the air-bone gap (ABG) closed to within 10 dB. This report highlights the value of integrating virtual endoscopy into stapes surgery planning to anticipate exposure limitations and guide targeted bony removal. The reverse sequence, combined with microtrephine fenestration, can be performed safely under endoscopic control. CT-based 3D virtual endoscopy can be a useful adjunct in planning endoscopic reverse stapedotomy, potentially optimizing surgical exposure and contributing to favorable anatomical and functional outcomes.