Endoscopic Ear Surgery – Summary of the Problem


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. 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


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Labels
Audiology Paediatric ENT ENT (Otorhinolaryngology)
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