{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T02:28:09Z","timestamp":1786328889003,"version":"build-2736575974"},"reference-count":26,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T00:00:00Z","timestamp":1786233600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: The objective of this study is to evaluate anatomical factors associated with operative time and audiological outcomes in endoscopic stapes surgery, with particular focus on quantitative temporal bone CT measurements. Methods: A retrospective review was conducted of 40 patients (51 ears) who underwent exclusive endoscopic stapes surgery between 1 April 2014 and 31 March 2023 by a single surgeon. Preoperative and postoperative audiometric data, operative time, and high-resolution temporal bone CT measurements\u2014including scutum angle and external auditory canal (EAC) cross-sectional area\u2014were analyzed. Correlation analysis was performed to assess associations with operative time and air\u2013bone gap (ABG) closure. Receiver operating characteristic (ROC) analysis was conducted as an exploratory assessment to identify anatomical thresholds associated with prolonged operative time. Additional analyses were performed to evaluate the potential influence of surgical period on operative time. Results: Significant improvements were observed in postoperative air conduction, bone conduction, and ABG (all p &lt; 0.0001). Mean ABG closure was 21.4 dB, and 74.5% of ears achieved postoperative ABG \u2264 10 dB. Operative time demonstrated a strong positive correlation with scutum angle (r = 0.8968, p &lt; 0.0001) and a moderate negative correlation with EAC area (r = \u22120.5759, p &lt; 0.0001). No significant correlation was identified between CT measurements and audiological outcomes. Exploratory ROC analysis suggested that an EAC area &lt; 0.1922 cm2 and scutum angle &gt; 71.4\u00b0 were associated with longer-than-median operative times. No significant difference in operative time was observed among the three predefined surgical periods, and linear regression analysis demonstrated no significant association between surgical period and operative time. Conclusions: Endoscopic stapes surgery provides favorable audiological outcomes. While preoperative CT-based anatomical parameters were not associated with hearing results, narrower EAC dimensions and larger scutum angles were associated with increased operative time under the endoscopic approach. These findings may facilitate preoperative surgical planning by identifying patients who are likely to present greater technical difficulty during endoscopic stapes surgery. However, the proposed CT thresholds should be regarded as exploratory findings and require prospective external validation before routine clinical implementation.<\/jats:p>","DOI":"10.3390\/diagnostics16162512","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T01:20:03Z","timestamp":1786324803000},"page":"2512","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["CT-Derived Anatomical Factors Associated with Operative Time and Hearing in Endoscopic Stapes Surgery: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"16","author":[{"given":"Shao-An","family":"Lu","sequence":"first","affiliation":[{"name":"Otorhinolaryngology Head and Neck Surgery Department, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111045, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8528-2347","authenticated-orcid":false,"given":"Yu-Hsuan","family":"Kuo","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology Head and Neck Surgery Department, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111045, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsing-Mei","family":"Wu","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology Head and Neck Surgery Department, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111045, Taiwan"},{"name":"Medical School, Fu-Jen Catholic University, New Taipei City 242062, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1177\/000348945806700403","article-title":"Fenestration of the oval window","volume":"67","author":"Shea","year":"1958","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/s00405-019-05688-y","article-title":"Endoscopic stapedotomy: Safety and audiological results in 150 patients","volume":"277","author":"Bianconi","year":"2020","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1001\/archotol.1967.00760040389009","article-title":"Fiberoptic endotoscopes for examining the middle ear","volume":"85","author":"Mer","year":"1967","journal-title":"Arch. Otolaryngol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1097\/MAO.0b013e318188e8d7","article-title":"Otoendoscopy in cholesteatoma surgery of the middle ear: What benefits can be expected?","volume":"29","author":"Ayache","year":"2008","journal-title":"Otol. Neurotol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1177\/000348949910800106","article-title":"Endoscopic middle ear surgery","volume":"108","author":"Tarabichi","year":"1999","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1002\/lio2.276","article-title":"An overview of endoscopic ear surgery in 2018","volume":"4","author":"Kapadiya","year":"2019","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1177\/0145561319862216","article-title":"Endoscopic Stapedotomy: Overcoming Limitations of Operating Microscope","volume":"100","author":"Das","year":"2021","journal-title":"Ear Nose Throat J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"NP679","DOI":"10.1177\/01455613221078183","article-title":"Perspectives and early experience on endoscopic stapedotomy from a group of \u201ctraditional school\u201d otologists","volume":"103","author":"Dutta","year":"2024","journal-title":"Ear Nose Throat J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1097\/00129492-200111000-00027","article-title":"Endoscope-guided round window fistula repair","volume":"22","author":"Karhuketo","year":"2001","journal-title":"Otol. Neurotol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1097\/MAO.0000000000000988","article-title":"Comparison of Middle Ear Visualization With Endoscopy and Microscopy","volume":"37","author":"Bennett","year":"2016","journal-title":"Otol. Neurotol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1007\/s00405-018-4905-8","article-title":"Middle ear microvascularization: An \u201cin vivo\u201d endoscopic anatomical study","volume":"275","author":"Guarino","year":"2018","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1002\/lary.24144","article-title":"Comparison between endoscopic and microscopic stapes surgery","volume":"124","author":"Kojima","year":"2014","journal-title":"Laryngoscope"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"6300","DOI":"10.3390\/jcm13216300","article-title":"Endoscopic Ear Surgery, from the Last Ten to the Next Ten Years: A Critical Perspective","volume":"13","author":"Molinari","year":"2024","journal-title":"J. Clin. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.anl.2016.07.001","article-title":"Endoscopic versus microscopic stapes surgery","volume":"44","author":"Surmelioglu","year":"2017","journal-title":"Auris Nasus Larynx"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1111\/coa.12051","article-title":"Endoscopic stapes surgery: Our experience in thirty two patients","volume":"38","author":"Sarkar","year":"2013","journal-title":"Clin. Otolaryngol."},{"key":"ref_16","first-page":"721","article-title":"Fully endoscopic stapes surgery (stapedotomy): Technique and preliminary results","volume":"77","author":"Martins","year":"2011","journal-title":"Braz. J. Otorhinolaryngol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1007\/s00405-015-3614-9","article-title":"Totally endoscopic stapes surgery without packing: Novel technique bringing most comfort to the patients","volume":"273","author":"Daneshi","year":"2016","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1007\/s00405-013-2420-5","article-title":"Endoscopic transcanal stapedotomy: How I do it","volume":"270","author":"Migirov","year":"2013","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1097\/MAO.0000000000001371","article-title":"Endoscopic Stapes Surgery: A Comparison With Microscopic Surgery","volume":"38","author":"Sproat","year":"2017","journal-title":"Otol. Neurotol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S25","DOI":"10.1097\/01.mao.0000235311.80066.df","article-title":"Surgical findings and long-term hearing results in 3,050 stapedotomies for primary otosclerosis: A prospective study with the otology-neurotology database","volume":"27","author":"Vincent","year":"2006","journal-title":"Otol. Neurotol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2175","DOI":"10.1007\/s00405-014-3113-4","article-title":"Outcome measures in stapes surgery: Postoperative results are independent from preoperative parameters","volume":"272","author":"Koopmann","year":"2015","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1097\/MAO.0000000000003145","article-title":"Stapes and Stapes Revision Surgery: Preoperative Air-Bone Gap Is a Prognostic Marker","volume":"42","author":"Sharaf","year":"2021","journal-title":"Otol. Neurotol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"458","DOI":"10.21037\/atm-22-1252","article-title":"A comparative study of changes in audiological characteristics when using endoscopic and microscopic stapes surgery in patients with otosclerosis","volume":"10","author":"Tang","year":"2022","journal-title":"Ann. Transl. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.12669\/pjms.35.5.439","article-title":"Comparison of surgical and audiological outcomes of endoscopic and microscopic approach in stapes surgery","volume":"35","author":"Gulsen","year":"2019","journal-title":"Pak. J. Med. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1080\/00016489.2018.1490029","article-title":"Fully endoscopic laser stapedotomy: Is it comparable with microscopic surgery?","volume":"138","author":"Kuo","year":"2018","journal-title":"Acta Oto-Laryngol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1097\/MAO.0000000000001186","article-title":"Endoscopic Versus Microscopic Approach in Stapes Surgery: Are Operative Times and Learning Curve Important for Making the Choice?","volume":"37","author":"Iannella","year":"2016","journal-title":"Otol. Neurotol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/16\/2512\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T01:32:07Z","timestamp":1786325527000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/16\/2512"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,9]]},"references-count":26,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["diagnostics16162512"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16162512","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,9]]}}}