Diagnostic Performance of Endoscopic and Microscopic Procedures for Identifying Different Middle Ear Structures and Remaining Disease in Patients with Chronic Otitis Media: A Prospective Cohort Study

Abstract

BackgroundThe diagnostic performance of endoscopic and microscopic procedures for detecting diseases of the middle ear in patients with chronic otitis media (COM) has rarely been investigated. This study was conducted to compare the performance of these procedures for identifying middle ear structures and their associated diseases in COM patients.MethodsIn this prospective cohort study, 58 patients with chronic COM, who were candidates for tympanoplasty with or without a mastoidectomy, were enrolled. Before the surgical intervention, the middle ear was examined via an operating microscope and then through an endoscope to identify the middle ear structures as well as diseases associated with the middle ear.ResultsThe patients were 15 years of age or older. The anatomical parts of the middle ear – the epitympanic, posterior mesotympanic, and hypotympanic structures – were more visible through an endoscope than through a microscope. In addition, the various segments of the mesotympanum, oval window, round window, and Eustachian tube were more visible via endoscopy. The post-operative endoscopic reevaluation of the middle ear revealed that a cholesteatoma had remained in four of 13 patients after surgery.ConclusionAccording to the results of this study, in cases in which there is poor visibility with the operating microscope or the surgeon suspects remaining disease within the middle ear, endoscopy could be utilized to improve the evaluation of more hidden middle ear pits and structures, particularly if there is a potentially recrudescent pathology.

Comparison of endoscopic transcanal and microscopic approach in Type 1 tympanoplasty

“… 7 , 8 , 9 Despite the significant advantages of the microscopic approach, such as providing the ability to work with both hands, offering stereoscopic vision,and requiring a shorter training period, the insufficiency to provide an adequate view of concealed areas in the middle ear without bone curettage or canaloplasty is the most important limitation of the microscopic approach, particularly in patients with narrow and curved external auditory canals. 10 , 11 , 12 The hidden areas in the middle ear space that can not be visualized directly with the surgical microscopes might be accessed easily without bone curettage or canaloplasty employing angled rigid endoscopes. The ETT with lower complication rates has considerable advantages such as being minimally invasive and providing shorter operative times, offering a panoramic view, and ensuring easy access to hidden areas.…”

Endoscopic vs Microscopic Approach in Stapes Surgery: Advantages in the Middle Ear Structures Visualization and Trainee's Point of View

“…This could be an important advantage to assistants in training who are inexperienced in recognition of middle ear structures. Third, the dynamic vision offered by endoscope movements could favor easier understanding of the surgical technique for assistants in training with little knowledge of the anatomy and surgical steps [6,37] . These hypotheses were evaluated via the specifically designed questionnaires.…”

Endoscope and image‐guided ventral bulla osteotomy in the dog: A cadaveric and patient study

“…Poor visualisation is likely a contributory factor in the high risk of complications and risk of recurrence of cholesteatoma reported for VBO in dogs. Operating loops or a microscope will improve the view, but they have a reduced visual field compared to the endoscope 12 . In our study the endoscope allowed reliable removal of disease from recesses that were hitherto invisible, and avoidance of injury to structures within the bulla that would also not otherwise be visualised.…”

“…Operating loops or a microscope will improve the view, but they have a reduced visual field compared to the endoscope. 12 In our study the endoscope allowed reliable removal of disease from recesses that were hitherto invisible, and avoidance of injury to structures within the bulla that would also not otherwise be visualised. Our approach also allowed a skin incision of 3-5 cm in length, which is half the 7-10 cm usually suggested for the ventral approach to the dog bulla (https://veteriankey.com/surgery-of-the-ear).…”