Endoscopic Ear Surgery – Summary of the Problem
Authors:
Richard Salzman
; T. Bakaj; J. Heřman; I. Stárek
Authors‘ workplace:
Otolaryngologická klinika Univerzity Palackého v Olomouci a FN Olomouc
Published in:
Otorinolaryngol Foniatr, 65, 2016, No. 3, pp. 184-187.
Category:
Review Article
Overview
Traditional ear surgery has reached its limits. Only introduction of new surgical technologies can expand the current boundaries. Endoscopic surgery reduced radicality by improved surgical field visualization in paranasal sinus surgery about 50 years ago. Initially endoscopes were introduced into otology as diagnostic tools for ear drum inspection in outpatient clinics. Only later on, they were accepted as surgical instrument - an adjunct to traditionally used microscopes. After Tarabichi and Marchioni mastered the use of endoscopes, primary endoscopic ear surgery was introduced about 15 years ago. Indications changed from simple procedures like myringo/ossiculoplasties, though cartilage tympanoplasties to removing large cholesteatomas using drills under endoscopic control.
Transmeatal endoscopic approach is less radical and offers wide field of view when compared to the technique using microscopes. Ability to look “round the corner” when using angled endoscopes, makes endoscope superior in removal of retraction pockets or cholesteatomas from regions inaccessible under direct view of a microscope. The use of endoscopes with varied angulations allows surgeons to get much better understanding of the middle ear anatomy and physiology in its complexity with all mucosal folds disrupting ventilation pathways.
Opponents point to disadvantages which include single-handedness, loss of depth perception, and limited magnification. In order to overcome single-handedness, meticulous hemostasis is necessary. Recently, it became easier to control minor bleeding and continue dissection after “suction” endoscopic instruments allowing suction and dissection with a single instrument in the same time became available on the market. Binocular operating microscope offers better depth perception which can, however, be substituted by endoscope’s wide view and capacity to look at middle ear structures under different angles.
The endoscopic ear surgery is, even though slowly, gaining worldwide acceptance. In October 2014, we started to perform purely endoscopic ear procedures at the Olomouc Department of Otolaryngology.
Keywords:
endoscopic, minimally invasive surgery, otoscopic, ear surgery
Sources
1. Ayache, S., Tramier, B., Strunski, V.: Otoendoscopy in cholesteatoma surgery of the middle ear: what benefits can be expected? Otol. Neurotik., 29, 2008, 8, s. 1085-1090.
2. Badr-el-Dine, M., James, A. L., Panetti, G., Marchioni, D., Presutti, L., Nogueira, J. F.: Instrumentation and technologies in endoscopic ear surgery. Otolaryngol. Clin. North Am., 46, 2013, 2, s. 211-225.
3. El-Meselaty, K., Badr-el-Dine, M., Mandour, M., Mourad, M., Darweesh, R.: Endoscope affects decision making in cholesteatoma surgery. Otolaryngol. Head Neck Surg., 129, 2003, 5, s. 490-496.
4. Gaillardin, L., Lescanne, E., Moriniere, S., Cottier, J. P., Robier, A.: Residual cholesteatoma: prevalence and location. Follow-up strategy in adults. Eur Ann. Otorhinolaryngol. Head Neck Dis., 129, 2012, 3, s. 136-140.
5. Hawke, M.: Telescopic otoscopy and photography of the tympanic membrane. J. Otolaryngol., 11, 1982, 1, s. 35-39.
6. Kakehata, S., Futai, K., Sasaki, A., Shinkawa, H.: Endoscopic transtympanic tympanoplasty in the treatment of conductive hearing loss: early results. Otol. Neurotik., 27, 2006, 1, s. 14-19.
7. Marchioni, D., Mattioli, F., Alicandri-Ciufelli, M., Presutti, L.: Endoscopic approach to tensor fold in patients with attic cholesteatoma. Acta Otolaryngol., 129,2009, 9, s. 946-954.
8. Marchioni, D., Villari, D., Mattioli, F., AlicandriI-Ciufelli, M., Piccinini, A., Presutti, L.: Endoscopic management of attic cholesteatoma: a single-institution experience. Otolaryngol. Clin. North Am., 46, 2013, 2, s. 201-209.
9. McKennan, K.: Endoscopic ‘second look’mastoidoscopy to rule out residual epitympanic/mastoid cholesteatoma. Laryngoscope, 103, 1993, 7, s. 810-814.
10. Mudry, A.: The history of the microscope for use in ear surgery. Otol. Neurotol., 21, 2000, 6, s. 877-886.
11. Nomura, Y.: Endoscopic photography of the middle ear. Otolaryngol. Head Neck Surg., 90, 1982, 4, s. 395-398.
12. Rosenberg, S., Silverstein, H., Willcox, T., Gordon, M.: Endoscopy in otology and neurotology. Otol., Neurotik., 15, 1994, 2, s. 168-172.
13. Takahashi, H., Honjo, I., Fujita, A, Kurata, K.: Transtympanic endoscopic findings in patients with otitis media with effusion. Arch Otolaryngol. Head Neck Surg., 116, 1990, 10, s. 1186-1189.
14. Tarabichi, M.: Endoscopic management of cholesteatoma: long-term results. Otolaryngol. Head Neck Surg., 122, 2000, 6, s. 874-881.
15. Tarabichi, M.: Endoscopic middle ear surgery. Ann. Otol. Rhinol. Laryngál., 108, 1999, 1, s. 39-46.
16. Tarabichi, M., Marchioni, D., Presutti, L., Nogueira, J. F., Pothier, D.: Endoscopic transcanal ear anatomy and dissection. Otolaryngol. Clin. North Am., 46, 2013, 2, s. 131-154.
17. Thomassin, J. M., Korchia, D., Doris, J. M. D.: Endoscopic--guided otosurgery in the prevention of residual cholesteatomas. Laryngoscope, 103, 1993, 8, s. 939-943.
18. Poe, D. S., Botrill, I. D.: Comparison of endoscopic and surgical explorations for perilymphatic fistulas. Otol. Neurotik., 15, 1994, 6, s. 735-738.
19. Yung, M. W.: The use of middle ear endoscopy: has residual cholesteatoma been eliminated? J. Laryngál. Otol., 115, 2001, 12, s. 958-961.
20. Yong, M., Mijovic, T., Lea, J.: Endoscopic ear surgery in Canada: a cross-sectional study. J. Otolaryngol. Head Neck Surg., 45, 2016, 1, s. 1-8.
Labels
Audiology Paediatric ENT ENT (Otorhinolaryngology)Article was published in
Otorhinolaryngology and Phoniatrics
2016 Issue 3
Most read in this issue
- Nanoparticles, Nanotoxicology, Nanomedicine: Definition of Terms, Perspectives in Otorhinolaryngology
- Secretory Carcinoma of Salivary Glands
- Orbitocellulitis - Potential Complication of Acute Rhinosinusitis Even with Proper Conservative Therapy
- Ganglioneuroma, a Rare Cause of Soft Neck Tissues Tumor in Adult Age