Current trends and applications in endoscopy for otology and neurotology

Abstract

There has been a rapid increase in endoscopic ear surgery for the management of middle ear and lateral skull base disease in children and adults over the last decade. In this review paper, we discuss the current trends and applications of the endoscope in the field of otology and neurotology. Advantages of the endoscope include excellent ergonomics, compatibility with pediatric anatomy, and improved access to the middle ear through the external auditory canal. Transcanal endoscopic ear surgery has demonstrated comparable outcomes in the management of cholesteatoma, tympanic membrane perforations, and otosclerosis as compared to microscopic approaches, while utilizing less invasive surgical corridors and reducing the need for postauricular incisions. When a postauricular approach is required, the endoscopic-assisted transmastoid approach can avoid a canal wall down mastoidectomy in cases of cholesteatoma. The endoscope also has utility in treatment of superior canal dehiscence and various skull base lesions including glomus tumors, meningiomas, and vestibular schwannomas. Outside of the operating room, the endoscope can be used during examination of the outer and middle ear and for debridement of complex mastoid cavities. For these reasons, the endoscope is currently poised to transform the field of otology and neurotology.

Intraoperative Neck Angles in Endoscopic and Microscopic Otologic Surgeries

“…Choi et al 30 found that minimally invasive tympanoplasty performed with an endoscope resulted in shorter operative times and less postoperative pain for the patient. The highly maneuverable tool enables excellent visualization and also allows everyone on the surgical team to gain a similar view of the operating field 16 . We found the average neck angles to be comparable between microscopic and endoscopic surgery with the caveat of increased time spent in neck extension when using a microscope.…”

“…Endoscopes are emerging as indispensable tools in minimally invasive otology procedures 16 . Choi et al 30 found that minimally invasive tympanoplasty performed with an endoscope resulted in shorter operative times and less postoperative pain for the patient.…”

“…With the advent of endoscopic ear surgery, we expected a potential improvement in surgical ergonomics with the use of a "heads up" display, as has been shown in other fields of surgery. 14,16,24,25 However, both endoscopic and microscopic surgery produced neck angles where surgeons spent the majority of operating time in ergonomically unfavorable positions based on the validated RULA risk calculation tool. Furthermore, the quantitative data did not identify large differences in neck angles between the 2 surgical techniques.…”

Endoscopic Management of Glomus Tympanicum Tumor: Report of Three Cases and Review of the Literature

“…EES has gained popularity over the last years, due to its advantages, which include a wide field of view, magnified vision, and the ability to visualize around corners [5,8,9]. As a result, its indications have expanded from cholesteatoma and stapes surgery to more complex procedures such as middle ear tumor excision and lateral skull base surgery, either via a total endoscopic approach or in combination with microscopic surgery [5,10,11]. GTT have as well been managed through an endoscopic approach and, since 2013, 13 studies have been published, to our knowledge, including 95 patients (Tables 3 and 4).…”

Essential equipment and services for otolaryngology care: a proposal by the Global Otolaryngology-Head and Neck Surgery Initiative

“…Otoendoscopes were also deemed aspirational at the primary level (Table 1 ), despite evidence demonstrating ergonomic benefits [ 50 ] and similar outcomes compared to traditional microscopic ear surgery [ 51 , 52 ]. This is perhaps due to its relatively recent arrival to the otology armamentarium and its steep learning curve for those trained only with operative microscopes to reliably benefit from the use of otology equipment [ 53 ]. It should be noted that at the tertiary level, only computer-assisted navigation for skull base surgery was deemed aspirational (Table 1 ).…”