Minimally Invasive Transcanal Endoscopic Ear Surgery

Abstract

Endoscopes have rapidly become widely accepted in the performance of ear surgery. Current chapter describes surgical technique and benefits and limitations for endoscopic eradication of cholesteatoma, endoscopic tympanoplasty, endoscopic stapedotomy and endoscopic cochlear implantation.Minimally invasive endoscopic and endoscope-assisted surgical techniques are increasingly being employed in the surgical management of cholesteatoma. Endoscopic surgeries distinctly reduced residual cholesteatomas and the indications of later tympanotomy thanks to the good visualization of residual cholesteatoma sites, such as the anterior and posterior epitympanic spaces, sinus tympani, facial recess, and hypotympanum. Minimally invasive transcanal endoscopic approach can be applied as for primary cholesteatomas as well as for revision of CWU cases, when residual/recurrent cholesteatoma is confined to the middle ear, and in CWD or radical cavities, when residual/recurrent disease is hidden in the supratubal recess, sinus tympani or under pseudo-membrane in the large mastoid cavities.The use of endoscopes in myringoplasty is especially helpful in patients with narrow external canals, anterior defects and bone overhang, when perforation's margins are barely, if at all, visible under a microscope.The transcanal endoscopic stapedotomy can be beneficial in improving the visibility and accessibility of the stapes and the oval window niche, avoiding manipulation of the chorda tympani nerve and blind fracture of the stapedial crurae.An endoscopic cochlear implantation involves entering the middle ear by means of endoscopic transcanal tympanotomy and insertion of the electrode array into the scala tympani via the round window under direct endoscopic control. The main benefits of the endoscopic transcanal approach to cochlear implant are improving the visibility and accessibility of the round window membrane, obviating the need to divide the chorda tympani nerve in order to obtain adequate exposure of the middle ear structures, and eliminating the risk of the facial nerve injury since it is not in the direction of drilling.

Endoscopic Myringoplasty Versus Microscopic Myringoplasty in Tubotympanic CSOM: A Comparative Study of 120 Cases

“…Minimally invasive endoscopic and endoscope-assisted surgical techniques are increasingly being employed in the surgical management of cholesteatoma as they help in good visualization of residual cholesteatoma sites, such as the anterior and posterior epitympanic spaces, sinus tympani, facial recess, and hypotympanum. The endoscope is also being used for transcanal stapedotomy, endoscopic repair of cerebro-spinal fluid otorrhoea, management of meniere's disease, management of perilymphatic fistulae and endoscopic cochlear implantation [19]. Thus endoscope holds the greatest promise in ear surgery in coming days.…”

Minimal Invasive Endoscopic Ear Surgery: A Two Handed Technique

“…The advantages of endoscopes in ear surgery include (1) visualization of the whole tympanic membrane and the ear canal without manipulation of the patient's head or the microscope, (2) extension of the operative field in transcanal procedures into structures usually hidden from the microscope (anterior tympanic perforation, posterior retraction pocket, facial recess, and hypotympanum) and (3) visualization of structures from multiple angles as opposed to the microscope's single axis along the ear canal [1,2]. In cholesteatoma surgery, the use of endoscopes has reduced the incidence of residual disease [3].…”