Endoscopic Ear Surgery: First Experience

Authors: R. Salzman;  T. Bakaj;  J. Heřman;  I. Stárek
Authors‘ workplace: Otolaryngologická klinika Univerzity Palackého v Olomouci a FN Olomouc
Published in: Otorinolaryng. a Foniat. /Prague/, 65, 2016, No. 3, pp. 168-172.
Category: Original Papers


Endoscopes were just recently established in the otology in order to decrease invasiveness of ear surgeries. Initially, endoscopes were used as an adjunct to the traditional ear surgery using microscopic technique to improve visualization of areas, e.g. attic and retrotympanum, which were difficult to reach with microscope and which are known to be responsible for numerous cases of persistent cholesteatomas. From the beginning of the 21st century, endoscopes, in some centers, took a role of the primary surgical tools of visualization. The ENT department in Olomouc probably became one of very first centers in the central Europe where purely endoscopic ear surgeries were introduced in October 2014.

to audit efficacy and safety of newly introduced endoscopic technique in the ear surgery

The subjects were 18 adult patients in whom endoscopic ear surgeries (stapedoplasty 4x, ossiculoplasty 7x, tympanoplasty for retraction pockets and smaller cholesteatomas 7x) were performed during the 12 month period from October 2014 to October 2015. All procedures were performed by a single surgeon using 30 degree 18 cm long endoscopes with diameter 2.7 or 4 mm. The postoperative hearing results were reported as pure-tone averages for air conduction calculated as the mean of the 500-, 1000-, 2000- and 4000 Hz. Similarly the air bone gaps were calculated as mean values on the above 4 frequencies. Furthermore, incidence of residual or recurrent cholesteatoma, complication rate, and number of endoscopic procedures converted to microscopic technique were assessed. Hearing was measured 1-30 days prior to the surgery and at the end of follow up period (2-14 months, median 6,1).

Patients’ hearing was improved with postoperative air-bone gap reduction of 20.3±7.4 dB after stapedoplasties, 8.6±12.1 dB after ossiculoplasties, and 2.3±5.6 dB after tympanoplasties. The mean air conduction threshold was 7.2±5.1 dB after stapedoplasties, 12. 5±7.5 dB after ossiculoplasties, and 12.5±11.2 dB after tympanoplasties.

Postoperative ABG closure (<10 dB) was seen in 75 % of patients after stapedoplasties, in 57,1 % after both ossiculoplasties and tympanoplasties.

In our cohort, a single patient was found to have persistent residual cholesteatoma pearl during the second look procedure. The remaining patients were free of residual or recurrent disease.

A single surgery was converted to microscopic technique as moderate bleeding obstructed view of the endoscope. It was relatively easy to control the bleeding and carry on with the surgery using both hands.

We encountered 2 complications (benign paroxysmal positional vertigo after ossiculoplasty and multiple cerebral venous trombosis after stapedoplasty).

Our audit confirms that endoscopic ear surgery offers comparable results and complication rates to traditional microscopic technique. These results entitle us to carry on with this type of minimally invasive ear surgeries.

endoscopic, minimally invasive surgery, otoscopic, ear surgery


1. Aksoy, F., Dogan, R., Eren, O., Veyseller, S. B., Gedik, O.: Thermal effects of cold light sources used in otologic surgery. Eur. Arch. Otorhinolaryngo., 2014, s. 1-9.

2. Atacan, E., Sennaroglu, L., Genc, A., Kaya, S.: Benign paroxysmal positional vertigo after stapedectomy. Laryngoscope, 111, 2001, 7, s. 1257-1259.

3. Ayache, S., Tramier, B., Strunski, V.: Otoendoscopy in cholesteatoma surgery of the middle ear: what benefits can be expected? Otol. Neurotol., 29, 2008, 8, s. 1085-1090.

4. Badr-el-Dine, M.: Value of ear endoscopy in cholesteatoma surgery. Otol. Neurotol., 23, 2002, 5, s. 631-635.

5. De Bruijn, S. F. T. M., Stam, J., Koopman, M. M. W., Vandenbroucke, J. P.: Case-control study of risk of cerebral sinus thrombosis in oral contraceptive users who are carriers of hereditary prothrombotic conditions. BMJ, 316, 7131, 1998, s. 589-592.

6. 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.

7. Funamura, J. L., Nguyen, A. T., Diaz, R. C.: Otogenic lateral sinus thrombosis: case series and controversies. Int J. Pediatr Otorhinolaryngol., 78, 2014, 5, s. 866-870.

8. 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.

9. Kojima, H., Komori, M., Chikazawa, S., Yaguchi, Y., Yamamoto, K., Chujo, K., Moriyama, H.: Comparison between endoscopic and microscopic stapes surgery. Laryngoscope, 124, 2014, 1, s. 266-271.

10. Kozin, E. D., Gulati, S., Kaplan, A. B., Lehmann, A. E., Remenschneider, A. K., Landegger, L. D., Cohen, M. S., Lee, D. J.: Systematic review of outcomes following observational and operative endoscopic middle ear surgery. Laryngoskope, 125, 2015, 5, s. 1205-1214.

11. Kozin, E. D., Lehmann, A., Carter, M., Hight, E., Cohen, M., Nakajima, H. H., Lee, D. J.: Thermal effects of endoscopy in a human temporal bone model: Implications for endoscopic ear surgery. Laryngoscope, 124, 2014, 8, s. E332-E339.

12. MacKeith, S. A., Frampton, S., Pothier, D. D.: Thermal properties of operative endoscopes used in otorhinolaryngology. J. Laryngol., Otol., 122, 2008, 7, s. 711–714.

13. 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.

14. Martinelli, I., Landi, G., Merati, G., Cella, R., Tosetto, A., Mannucci, P. M.: Factor V gene mutation is a risk factor for cerebral venous thrombosis. Thromb Haemost, 75, 1996, 3, s. 393-394.

15. Mijovic, T., Lea, J.: Training and education in endoscopic ear surgery. Curr. Otorhinolaryngol. Rep., 3, 2015, 4, s. 193-199.

16. Shcherbina, I. A., Lipets, E. N., Abaeva, A. A., Balandina, A. N., Ataullakhanov, F. I.: Influence of temperature on spatial fibrin clot formation process in thrombodynamics assay. Biochem. (Mosc) Suppl. Ser. B: Biomedical Chemistry, 7, 2013, 4, s. 311-318.

17. Sitton, M. S., Chun, R.: Pediatric otogenic lateral sinus thrombosis: role of anticoagulation and surgery. Int. J. Pediatr. Otolaryngol., 76, 2012, 3, s. 428-432.

18. Stoll, A. M., Greene, L. C.: Relationship between pain and tissue damage due to thermal radiation. Journal of Applied Physiology, 14, 1959, 3, s. 373-382.

19. Tarabichi, M.: Endoscopic management of cholesteatoma: long-term results. Otolaryngol. Head Neck Surg., 122, 200, 6, s. 874-881.

20. Watts, D. D., Trask, A., Soeken, K., Perdue, P., Dols, S., Kaufmann, C.: Hypothermic coagulopathy in trauma: effect of varying levels of hypothermia on enzyme speed, platelet function, and fibrinolytic activity. J. Trauma Acute Care Surg., 44, 1998, 5, s. 846-854.

21. Yung, M. W.: The use of middle ear endoscopy: has residual cholesteatoma been eliminated? J. Laryngál. Otol., 115, 2001, 12, s. 958-961.

Audiology Paediatric ENT ENT (Otorhinolaryngology)
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