Endoscopic Stapes Surgery: Our Long-Term Audiological Outcomes and Literature Review

ABSTRACTObjective: This study evaluates 12-month audiological outcomes of full endoscopic transcanal stapedotomy for otosclerosis, analyzing surgical success, hearing gain, and complications relative to existing literature.Materials and Methods: The data of 50 patients who underwent endoscopic stapes surgery for otosclerosis between January 2024 and June 2025 at our clinic were retrospectively reviewed. All operations were performed by the same surgeon using a 2.7 mm 0° and 3.0 mm 30° rigid endoscopes. The patients' preoperative and 12-month postoperative pure-tone audiometry thresholds (0.5, 1, 2, and 4 kHz) were recorded. The air-bone gap (ABG) was calculated as the difference between the air pathway and bone pathway averages; ABG values were also calculated separately for each frequency (0.5, 1, 2, and 4 kHz) to perform frequency-based analyses. Surgical success was defined as an air-bone gap ABG ≤10 dB at 12 months postoperatively. Dependent t-tests and regression analysis were used to analyze the data.Results: The mean age of the patients included in the study was 45.22 ± 10.46 years, and 58% were female. The mean total ABG, which was 34.12 ± 10.54 dB in the preoperative period, showed a statistically significant decrease at 12 months postoperatively, recorded as 9.92 ± 6.48 dB (p < 0.001). The mean functional hearing gain was calculated as 24.20 ± 10.16 dB. Surgical success was achieved in 94.0% of patients (n=47) with ABG ≤10 dB. No significant effect of age, gender, or surgical side on hearing gain was detected.Conclusions: Endoscopic stapes surgery provides a reliable, minimally invasive alternative to microscopic techniques, achieving a 94% success rate. Despite one-handed technical limitations, its superior wide-angle visualization and reduced chorda tympani manipulation ensure stable, effective long-term results, making it a preferred surgical option for managing otosclerosis