Search

Introduction: Preserving the cochlear structures and thus hearing preservation, has become a prominent topic of discussion in cochlear implant (CI) surgery. Various approaches and soft surgical techniques have been described when approaching the inner ear. Robot-assisted cochlear implant surgery (RACIS) reaches the round window in a minimally invasive manner by following a trajectory of minimal trauma. This involves the drilling of a keyhole trajectory to the round window, through the facial recess, with no need for a complete mastoidectomy. It involves less drilling, less drilling time and less structural damage. A lot of attention has been paid to the structural traumatic causes of hearing loss but acoustic trauma during the exposure of the inner ear appears to be neglected topic. Aim: The aim was to measure the noise exposure of the inner ear during the robotic drilling of the mastoid and bony overhang of the round window. The results were compared with the milling in conventional cochlear implantation surgery. Intervention: RACIS on fresh frozen human cadavers. Outcome measurements: The equivalent frequency-weighted and time-averaged sound pressure level LAF in dB and the noise dose in % derived from a noise damage model, both obtained during RACIS. Materials and methods: The robotic drilling of 6 trajectories towards the inner ear were performed, including 4 trajectories through round window access and 2 trajectories through cochleostomy. The results were compared with the data of 7 cases of conventional CI surgery that have been described in literature. The induced equivalent sound pressure level LAF was determined via an accelleration sensor at the zygomatic arch and a calibration according to bone conduction audiometry. A noise dose for the whole procedure was calculated from the equivalent sound pressure level LAF and the exposure time using a noise damage model. A noise dose of 100% is considered a critical exposure limit and values above are considered potentially harmful, with the risk of hearing impairment. Results: The maximum LAF was 82 dB during fiducial screw placement; 87 dB during middle ear access; 95 dB for the accesses through the round window and 88 dB for the accesses through cochleostomy. The noise dose due to the HEARO®-procedure was always far below the critical value of 100%. There was no acoustic trauma of the inner ear in all cases with the noise dose being smaller than 0.1% in five out of the six cases. The maximum LAF in the seven cases of conventional CI surgery was 118 dB with a maximum cumulative noise dose of 172.6%. The critical exposure limit of 100% was exceeded in three cases of conventional CI surgery. Conclusion: RACIS provokes significantly less acoustic trauma than conventional mastoid surgery in our findings. There were no observable differences in noise exposure levels between a cochleostomy or a round window approach where the bony overhang needed to be drilled. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to determine whether preoperative depressiveness, stress, and personality influence quality of life (QOL) after cochlear implant (CI) surgery. Methods: In this prospective study, 79 patients undergoing CI surgery were evaluated preoperatively and 12 months postoperatively. Disease-specific QOL was assessed with the Nijmegen Cochlear Implant Questionnaire (NCIQ) and general QOL with the WHOQOL-BREF. Depressiveness and stress were assessed with the Patient Health Questionnaire (PHQ-D). The Charlson Comorbidity Index (CCI) was used to classify comorbidities. The Big Five Personality Test (B5T) was used to assess the basic personality dimensions. Speech comprehension was evaluated in quiet with the Freiburg monosyllable test and in noise with the Oldenburg sentence test. Results: After CI surgery, the total NCIQ score improved significantly (Δ 17.1 ± 14.7, p < 0.001). General QOL (WHOQOL-BREF, Δ 0.4 ± 9.9, p = 0.357), stress (Δ 0.25 ± 3.21, p = 0.486), and depressiveness (Δ 0.52 ± 3.21, p = 0.121) were unaffected by CI surgery. Patients without elevated depressiveness (p < 0.01) or stress (p < 0.001) had significantly better total NCIQ scores. The results of the multiple regression analyses show that, after adjusting for the CCI, personality, age, and mental health stress (ß = − 0.495, p < 0.001) was significantly associated with postoperative NCIQ outcome scores. Depressiveness and neuroticism had the strongest influence on the generic QOL (ß = − 0.286 and ß = − 0.277, p < 0.05). Conclusion: Stress symptoms and personality traits are significant predictive factors for disease-specific QOL, as well as hearing status. This should be considered in the preoperative consultation and in optimizing the rehabilitation process. [ABSTRACT FROM AUTHOR]

Purpose: Evaluating the current health state in chronic otitis media (COM), audiologic results are complemented by subjective outcomes, such as health-related quality of life (HRQoL). Two disease-specific instruments assessing HRQoL in COM in German-speaking patients exist, i.e., the chronic otitis media outcome test (COMOT-15) and the Zurich chronic middle ear inventory (ZCMEI-21). Since the psychometric properties of these questionnaires in a concurrent application are unknown, the aim of this study was to compare the COMOT-15 and the ZCMEI-21. Methods: HRQoL was assessed in adult COM patients using the COMOT-15 and the ZCMEI-21. Psychometric properties were determined, including response distribution, concurrent validity, internal consistency, correlation to hearing and gender differences. Results: In 173 patients (mean age 51.5 years), both questionnaires showed normally distributed scores without strong floor and ceiling effects. The total scores and subscores of both questionnaires exhibited satisfactory internal consistency (Cronbach's α 0.7–0.9) with the exception of the COMOT-15 hearing subscore (α = 0.94) and the ZCMEI-21 medical resource subscore (α = 0.66). Fair correlations between the air conduction pure-tone average and the total scores were found (COMOT-15: r = 0.36, p < 0.0001; ZCMEI-21: r = 0.34, p < 0.0001). Conclusion: In the first study comparing the COMOT-15 and the ZCMEI-21, both questionnaires exhibited satisfactory psychometric properties with several subtle differences. The COMOT-15 has a strong focus on hearing with a probably redundant content of the hearing subscore and may be suited for hearing-focused research questions. The ZCMEI-21 provides a comprehensive assessment of the COM symptom complex and may therefore also be used in research settings, where ear discharge, vertigo or pain should be covered. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to determine whether preoperative depressive symptoms influence health-related quality of life (HRQOL) after middle ear surgery in patients with chronic otitis media (COM). Methods: This prospective clinical case study was conducted at a tertiary referral center. All 102 patients who had undergone middle ear surgery for COM were assessed clinically and by audiometric testing (pure tone audiometry) in pre- and postoperative settings. Disease-specific HRQOL was assessed by the validated chronic otitis media outcome test 15 (COMOT-15) and the Zurich chronic middle ear inventory (ZCMEI-21). General HRQOL was measured using the short form 36 (SF-36). Depressive symptoms were assessed using the patient health questionnaire (PHQ-D). The Charlson comorbidity index (CCI) was used to classify comorbidities. The middle ear status was determined using the ossiculoplasty outcome parameter staging (OOPS) index. Results: After middle ear surgery, the total COMOT-15 and ZCMEI-21 scores improved significantly (p < 0.001). General HRQOL (total SF-36 score) was unaffected by surgery (p < 0.05). Patients without elevated depressive symptoms had significantly better total scores for the COMOT-15 (p < 0.01), ZCMEI-21 (p < 0.001), and for SF-36 (p < 0.001) postoperatively. The results of the multiple regression analyses show that, after adjusting for the OOPS, CCI, and hearing improvement, preoperative depressiveness was significantly associated with worse postoperative COMOT-15 and ZCMEI-21 outcome scores (β = 0.425 and β = 0.362, p < 0.001). Conclusion: Preoperative depressiveness was an essential predictive factor for HRQOL in patients with COM. This should be considered during patient selection to provide more suitable preoperative counseling. [ABSTRACT FROM AUTHOR]

Objectives: The use of standardized outcome parameters is essential for the comparability of clinical studies. Pure-tone audiometry and speech audiometry are widely used, but there is no systematic evaluation of the outcome parameters in clinical application. Nevertheless, there is presumably a great heterogeneity especially in the field of speech audiometry. This study presents a snapshot of the current situation of documentation and usage of outcome parameters in otologic research. Study design: Retrospective study of existing literature analyzing common speech audiometric test material and procedure Main outcome measures: Intervention Studies from 2012 to 2016 concerning hearing ability were eligible for evaluation. Studies were analyzed with regard to study design, pathology and intervention, speech audiometric parameters, pure-tone audiometry, implementation of reporting standards and journal related data. Results: 279 studies were included. Over 50% of the analyzed studies lacked proper documentation. In the remaining studies, there was a broad variance concerning the documented speech audiometric parameters, most often with a fixed presentation level of 65 dB SPL. Conclusion: The lack of generally used standards for reporting hearing outcomes makes it difficult to compare results of different clinical studies. An adequate description of the methods would be a first and important step in improving reports on audiological outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Otosclerosis is associated with hearing disability, leading to communication deficits and social and psychological restrictions. The objective of our study was to analyze disease-specific health-related quality of life (HRQOL) after stapes surgery and compare the outcome of HRQOL with audiometric parameters. Subjects and Methods: Our clinical case study was conducted at two tertiary referral centers. All the 37 patients who had undergone stapes surgery were analyzed clinically and by audiometric testing (pure tone and speech audiometry) in the pre- and postoperative settings. Disease-specific HRQOL was assessed by the validated Stapesplasty Outcome Test 25 (SPOT-25) pre- and postoperatively. The subjective hearing disability was evaluated by the hearing handicap inventory for adults (HHIA). The postinterventional benefit was measured by the Glasgow Benefit Inventory (GBI). Results: Disease-specific HRQOL improved significantly after stapes surgery in all scales of the SPOT-25. Postoperatively, the total score and the subscore 'hearing function' correlated well with the audiometric data. The subscores 'tinnitus', 'social restrictions', and 'mental condition' did not show significant association with audiometric parameters. The comparison of pre- and postoperative HHIA offered a significant improvement in the hearing disability. The scores of the HHIA correlated very well with the audiometric data. The GBI showed a postoperative benefit for each individual patient. Conclusion: Stapes surgery leads to a significant improvement in the hearing handicap and of disease-specific HRQOL. The audiometric parameters were shown as not being a sufficient indicator of social and mental well-being. HRQOL outcome measuring instruments should be used routinely in clinical practice to provide an individualized postoperative assessment. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess hearing outcome after sequential cholesteatoma surgery stratified for exclusively transcanal technique (ETC), combined transcanal and transmastoidal technique (TCM) and canal wall down surgery (CWD) and to analyze the impact of ossicular reconstruction technique (partial ossicular replacement prostheses/PORP and total ossicular replacement prostheses/TORP) on hearing outcome. This study is a retrospective case review and clinical case study conducted in a tertiary referral center. Patients who underwent 376 cholesteatoma surgeries (2007-2009) and 92 ears in clinical re-examination at least 12 months postoperatively were included. Sequential cholesteatoma surgery with ETC, TCM, or CWD; ossiculoplasty with PORP or TORP were the interventions administered. Pre- and postoperative air-bone gap (ABG) and air conduction threshold (AC) for 0.5-3 kHz were the main outcome measures. Overall, the mean preoperative ABG decreased from 25.3 ± 1.3 to 19.8 ± 0.9 dB with a mean ABG closure of 5.4 ± 1.3 dB ( p ≤ 0.001). According to surgical technique, the postoperative ABG after CWD 23.5 ± 2.1 was significantly worse compared to ETC (17.3 ± 1.0 dB, p < 0.05) and TCM (19.4 ± 1.3 dB). A significant ABG closure was observed after ETC (6.8 ± 2.0 dB, p < 0.01) and TCM (6.5 ± 2.0 dB, p < 0.01) contrary to CWD (2.1 ± 2.9 dB, p > 0.05). Patients receiving PORP showed a significantly less ABG postoperatively (19.0 ± 0.9 dB, p ≤ 0.05) compared to the TORP group (24.1 ± 2.5 dB). However, a significant hearing gain was assessed after PORP- (4.7 ± 1.6 dB, p ≤ 0.01) and TORP- implantation (10.4 ± 3.7 dB, p ≤ 0.01). Sequential cholesteatoma surgery allowed for an excellent hearing outcome postoperatively. An intact posterior canal wall and a present stapes suprastructure were identified to predict a significantly superior hearing result. In addition to the technical and prosthetic considerations, the audiological outcome was confounded by the attending middle ear pathology. [ABSTRACT FROM AUTHOR]

The UEMS Otorhinolaryngology-Head and Neck Surgery section is a dedicated body formed to promote the standardisation and harmonisation of European Otorhinolaryngology (ORL). The European Examination Board of Otorhinolaryngology and Head and Neck Surgery was created to establish a supranational final exam and accreditation for ORL Surgeons. It is open to candidates both from the European Union and outside the EU. The exam is composed of a written examination to assess mainly the theoretical knowledge of Otorhinolaryngological diseases. The second part, a viva voce examination, is designed to test the clinical application of knowledge based on case scenarios and clinical conditions presented to the candidates. The inaugural examination written component took place in Mannheim/Germany in 2009 and the inaugural Viva Voce examination in Vienna/Austria in 2010. Up to and including the year 2013, 858 participants have attempted one of the two exam components. Of the 858 participants, 305 were successful in both examinations and obtained the accreditation of the European Diploma (European Board Certification). The historical origins, development of the examination, its formal arrangements and the format of the examination are presented in this article. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare health-related quality of life (HRQOL) after sequential cholesteatoma surgery including exclusively transcanal technique (ETC), combined transcanal transmastoidal technique (TCM) and canal wall down surgery with obliteration (CWD). It was a clinical case study conducted in a tertiary referral center. 97 patients at least 12 months after cholesteatoma surgery were included. Interventions included sequential cholesteatoma surgery with ETC, TCM or CWD; ossiculoplasty with partial and total ossicular replacement prostheses. HRQOL assessed by Chronic Otitis Media Outcome Test 15 including an overall score and three subscores ('ear symptoms', 'hearing function' and 'mental health') as well as a general evaluation of HRQOL and the frequency of physician consultations, audiometric outcome related to HRQOL were the main outcome measures. Patients, who had undergone sequential cholesteatoma surgery, showed moderate restrictions in HRQOL postoperatively. Stratified for the three surgical techniques, patients receiving ETC tended to report lower restrictions in HRQOL. The ETC group offered a significantly lower value in the subscore 'ear symptoms'. The 'hearing function' was attributed to be the most restriction criteria for all techniques. The overall score and all subscores correlated moderately with the postoperative air conduction threshold. The strongest correlation coefficient was achieved for the subscore 'hearing function' ( r = 0.49, p < 0.001). Sequential cholesteatoma surgery offers acceptable moderate restrictions in HRQOL postoperatively. Patients receiving canal wall down surgery with obliteration showed equivalent limitations in HRQOL compared to closed techniques (ETC, TCM). The postoperative air conduction threshold was shown not to be a sufficient indicator for HRQOL. Therefore, disease-specific validated and reliable measuring instruments for HRQOL should be transferred from clinical research to clinical practice to provide an individualized postoperative assessment after cholesteatoma surgery. [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate the validity of the avian middle ear model for researching the tympanoplasty mechanics. We studied the morphological details, acoustic transmission and quasi-static behavior of the ostrich tympano-ossicular system. The stained specimens of the ostrich middle ear were examined under a light microscope. The sound transfer function and quasi-static performance of the ostrich middle ear were evaluated using laser Doppler vibrometry. The application of pressure to the tip of the extracolumella causes a buckling movement of the ossicle between the cartilaginous and bony parts. Histologically, the intracolumellar connection can be identified as a junction zone between bone and hyaline cartilage. Sound conduction through the human middle ear is less effective than it is through the ostrich middle ear. The greatest difference (35 dB) was observed in the low-frequency region. Because the extracolumella bends, the medial displacements of the eardrum were not fully transmitted to the footplate. The amplitude of the ostrich columella footplate quasi-static medial displacements significantly exceeded that of the human footplate in both intact and reconstructed middle ears. The ostrich middle ear is a suitable model for designing total ossicular replacement implants. The main protective mechanism in the ostrich middle ear under quasistatic stress is a buckling movement of the extracolumella. The total ossicular prostheses of the new generation should contain an elastic element that allows an adaptation to greater quasi-static eardrum movements. [ABSTRACT FROM AUTHOR]

Introduction: The success of partial ossicular chain reconstructions in cases of conductive hearing loss depends on many factors. One important factor is the coupling between the prosthesis and the stapes head, which has not been explicitly investigated previously. Prostheses with different forms of attachment to the stapes are available, namely clip and bell type PORP. We present a standardized method to assess the quality of the prosthesis-stapes connection. The coupling quality of different prostheses is compared using measurements on a specimen model.This study delineated six groups categorized by prosthesis types, employing 12 temporal bones to create a reconstructed ossicular chain model. The model comprised stapes and inner ear of the specimen, various prostheses and a standardized mechanical excitation at the prosthesis head. Multiple-points measurements were conducted using laser Doppler vibrometry along the sound transfer direction. This methodology enabled the assessment of vibrational magnitude loss and sound distortion from the prosthesis to the stapes.All six groups showed uniformly good sound transmission, with low magnitude loss of < 10 dB and very low total harmonic distortion of < 1%.The proposed measurement method enables an explicit and comparable examination of the prosthesis coupling to the stapes head. While the coupling mechanism may be important in terms of handling, stability or long-term robustness of the reconstruction, our results show no relevant differences between types in terms of sound transmission.Methods: The success of partial ossicular chain reconstructions in cases of conductive hearing loss depends on many factors. One important factor is the coupling between the prosthesis and the stapes head, which has not been explicitly investigated previously. Prostheses with different forms of attachment to the stapes are available, namely clip and bell type PORP. We present a standardized method to assess the quality of the prosthesis-stapes connection. The coupling quality of different prostheses is compared using measurements on a specimen model.This study delineated six groups categorized by prosthesis types, employing 12 temporal bones to create a reconstructed ossicular chain model. The model comprised stapes and inner ear of the specimen, various prostheses and a standardized mechanical excitation at the prosthesis head. Multiple-points measurements were conducted using laser Doppler vibrometry along the sound transfer direction. This methodology enabled the assessment of vibrational magnitude loss and sound distortion from the prosthesis to the stapes.All six groups showed uniformly good sound transmission, with low magnitude loss of < 10 dB and very low total harmonic distortion of < 1%.The proposed measurement method enables an explicit and comparable examination of the prosthesis coupling to the stapes head. While the coupling mechanism may be important in terms of handling, stability or long-term robustness of the reconstruction, our results show no relevant differences between types in terms of sound transmission.Results: The success of partial ossicular chain reconstructions in cases of conductive hearing loss depends on many factors. One important factor is the coupling between the prosthesis and the stapes head, which has not been explicitly investigated previously. Prostheses with different forms of attachment to the stapes are available, namely clip and bell type PORP. We present a standardized method to assess the quality of the prosthesis-stapes connection. The coupling quality of different prostheses is compared using measurements on a specimen model.This study delineated six groups categorized by prosthesis types, employing 12 temporal bones to create a reconstructed ossicular chain model. The model comprised stapes and inner ear of the specimen, various prostheses and a standardized mechanical excitation at the prosthesis head. Multiple-points measurements were conducted using laser Doppler vibrometry along the sound transfer direction. This methodology enabled the assessment of vibrational magnitude loss and sound distortion from the prosthesis to the stapes.All six groups showed uniformly good sound transmission, with low magnitude loss of < 10 dB and very low total harmonic distortion of < 1%.The proposed measurement method enables an explicit and comparable examination of the prosthesis coupling to the stapes head. While the coupling mechanism may be important in terms of handling, stability or long-term robustness of the reconstruction, our results show no relevant differences between types in terms of sound transmission.Conclusion: The success of partial ossicular chain reconstructions in cases of conductive hearing loss depends on many factors. One important factor is the coupling between the prosthesis and the stapes head, which has not been explicitly investigated previously. Prostheses with different forms of attachment to the stapes are available, namely clip and bell type PORP. We present a standardized method to assess the quality of the prosthesis-stapes connection. The coupling quality of different prostheses is compared using measurements on a specimen model.This study delineated six groups categorized by prosthesis types, employing 12 temporal bones to create a reconstructed ossicular chain model. The model comprised stapes and inner ear of the specimen, various prostheses and a standardized mechanical excitation at the prosthesis head. Multiple-points measurements were conducted using laser Doppler vibrometry along the sound transfer direction. This methodology enabled the assessment of vibrational magnitude loss and sound distortion from the prosthesis to the stapes.All six groups showed uniformly good sound transmission, with low magnitude loss of < 10 dB and very low total harmonic distortion of < 1%.The proposed measurement method enables an explicit and comparable examination of the prosthesis coupling to the stapes head. While the coupling mechanism may be important in terms of handling, stability or long-term robustness of the reconstruction, our results show no relevant differences between types in terms of sound transmission. [ABSTRACT FROM AUTHOR]

Background: This prospective study compared the application of a 3D exoscope (VITOM 3D) with surgical microscopes (SM) in ear surgery.62 patients were included (exoscope group (E+) n = 31; SM group (E-) n = 31). Procedures included cochlea implantation (nE + = 10, nE- = 10), reconstructive middle ear surgery due to chronic otitis media with (COMwC; nE + = 11, nE- = 11) and without cholesteatoma (COMsC; nE + = 10, nE- = 10). Objective (e.g. set-up time and wrap-up time, corrected cut-suture-time, pure operating time, adjustment time, time per adjustment procedure, learning curves) and subjective perioperative parameters were evaluated. This paper only addressed the analysis of the objective parameters.The pooled data showed that the mean time delay in the E + group was significantly higher compared to the E- group with regard to set-up time and wrap-up time, corrected cut-suture time, adjustment time and time per adjustment procedure. Time delay tended to be higher for pure operating time. In all subgroups of the E + group, the objective time parameters also showed at least a tendency to be prolonged on average compared to the corresponding subgroups in the E- group. The learning curve analysis showed that the E + group (corrected cut suture time for CI surgery, mean time per adjustment procedure across all subgroups) approached the times of the E- group during the course of the study.Based on the pooled data from the study arms, the exoscope tends to be inferior to the microscope for the objective time parameters evaluated when used in ear surgery. However, due to the small group sizes, no solid conclusions could be drawn regarding the individual surgical procedures. In addition, further studies with a longer observation period are needed to minimize the influence of the learning curve on the results.Methods: This prospective study compared the application of a 3D exoscope (VITOM 3D) with surgical microscopes (SM) in ear surgery.62 patients were included (exoscope group (E+) n = 31; SM group (E-) n = 31). Procedures included cochlea implantation (nE + = 10, nE- = 10), reconstructive middle ear surgery due to chronic otitis media with (COMwC; nE + = 11, nE- = 11) and without cholesteatoma (COMsC; nE + = 10, nE- = 10). Objective (e.g. set-up time and wrap-up time, corrected cut-suture-time, pure operating time, adjustment time, time per adjustment procedure, learning curves) and subjective perioperative parameters were evaluated. This paper only addressed the analysis of the objective parameters.The pooled data showed that the mean time delay in the E + group was significantly higher compared to the E- group with regard to set-up time and wrap-up time, corrected cut-suture time, adjustment time and time per adjustment procedure. Time delay tended to be higher for pure operating time. In all subgroups of the E + group, the objective time parameters also showed at least a tendency to be prolonged on average compared to the corresponding subgroups in the E- group. The learning curve analysis showed that the E + group (corrected cut suture time for CI surgery, mean time per adjustment procedure across all subgroups) approached the times of the E- group during the course of the study.Based on the pooled data from the study arms, the exoscope tends to be inferior to the microscope for the objective time parameters evaluated when used in ear surgery. However, due to the small group sizes, no solid conclusions could be drawn regarding the individual surgical procedures. In addition, further studies with a longer observation period are needed to minimize the influence of the learning curve on the results.Results: This prospective study compared the application of a 3D exoscope (VITOM 3D) with surgical microscopes (SM) in ear surgery.62 patients were included (exoscope group (E+) n = 31; SM group (E-) n = 31). Procedures included cochlea implantation (nE + = 10, nE- = 10), reconstructive middle ear surgery due to chronic otitis media with (COMwC; nE + = 11, nE- = 11) and without cholesteatoma (COMsC; nE + = 10, nE- = 10). Objective (e.g. set-up time and wrap-up time, corrected cut-suture-time, pure operating time, adjustment time, time per adjustment procedure, learning curves) and subjective perioperative parameters were evaluated. This paper only addressed the analysis of the objective parameters.The pooled data showed that the mean time delay in the E + group was significantly higher compared to the E- group with regard to set-up time and wrap-up time, corrected cut-suture time, adjustment time and time per adjustment procedure. Time delay tended to be higher for pure operating time. In all subgroups of the E + group, the objective time parameters also showed at least a tendency to be prolonged on average compared to the corresponding subgroups in the E- group. The learning curve analysis showed that the E + group (corrected cut suture time for CI surgery, mean time per adjustment procedure across all subgroups) approached the times of the E- group during the course of the study.Based on the pooled data from the study arms, the exoscope tends to be inferior to the microscope for the objective time parameters evaluated when used in ear surgery. However, due to the small group sizes, no solid conclusions could be drawn regarding the individual surgical procedures. In addition, further studies with a longer observation period are needed to minimize the influence of the learning curve on the results.Conclusions: This prospective study compared the application of a 3D exoscope (VITOM 3D) with surgical microscopes (SM) in ear surgery.62 patients were included (exoscope group (E+) n = 31; SM group (E-) n = 31). Procedures included cochlea implantation (nE + = 10, nE- = 10), reconstructive middle ear surgery due to chronic otitis media with (COMwC; nE + = 11, nE- = 11) and without cholesteatoma (COMsC; nE + = 10, nE- = 10). Objective (e.g. set-up time and wrap-up time, corrected cut-suture-time, pure operating time, adjustment time, time per adjustment procedure, learning curves) and subjective perioperative parameters were evaluated. This paper only addressed the analysis of the objective parameters.The pooled data showed that the mean time delay in the E + group was significantly higher compared to the E- group with regard to set-up time and wrap-up time, corrected cut-suture time, adjustment time and time per adjustment procedure. Time delay tended to be higher for pure operating time. In all subgroups of the E + group, the objective time parameters also showed at least a tendency to be prolonged on average compared to the corresponding subgroups in the E- group. The learning curve analysis showed that the E + group (corrected cut suture time for CI surgery, mean time per adjustment procedure across all subgroups) approached the times of the E- group during the course of the study.Based on the pooled data from the study arms, the exoscope tends to be inferior to the microscope for the objective time parameters evaluated when used in ear surgery. However, due to the small group sizes, no solid conclusions could be drawn regarding the individual surgical procedures. In addition, further studies with a longer observation period are needed to minimize the influence of the learning curve on the results. [ABSTRACT FROM AUTHOR]