The effect of light intensity on image quality in endoscopic ear surgery

McCallum, Rhona; McColl, John H.; Iyer, Arunachalam

doi:10.1111/coa.13139

Cited by 14 publications

(14 citation statements)

References 16 publications

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“…12 A decrease in light intensity, which is protective for the inner ear, is not associated with a deterioration in the image quality. 13,14 An optimal balance between the intensity of the light used as well as the image quality can be achieved in most cases when the intensity is kept at 50 per cent. 15 Therefore, we used 50 per cent intensity in our study.…”

Section: Discussionmentioning

confidence: 99%

Prolonged intra-operative thermal exposure in endoscopic ear surgery: is it really safe?

et al. 2020

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Objective The aim of this study was to assess change in temperature, audiometric outcomes and post-operative complications following exposure to different light sources during endoscopic ear surgery. Method A total of 64 patients diagnosed with chronic otitis media with central perforation and pure conductive hearing loss underwent endoscopic type 1 tympanoplasty. The patients were randomised into two groups based on the light source used: xenon or light-emitting diode. Temperature was measured using a K type thermocouple at the promontory and round window niche. Mean temperature change with respect to operating time, mean audiometric change, incidence of vomiting in the first 24 hours, vertigo and tinnitus at the end of the first week were observed. Results Mean temperature change showed a statistically significant difference with increasing length of operating time with the xenon light source and when the two light sources were compared for a particular time interval. Mean audiometric change showed statistically significant deterioration at higher frequencies (4, 6 and 8 kHz) with the xenon light source but only at 8 kHz for the light emitting diode source. When the mean audiometric change was compared between light sources for a particular frequency, statistical significance was found at 4, 6 and 8 kHz. Post-operative complications were vomiting, vertigo and tinnitus (p-values of 0.042, 0.099 and 0.147, respectively, between two groups). Conclusion Light emitting diodes are associated with less significant middle-ear temperature rises and audiometric changes at higher frequencies when compared to xenon light sources. Hence, xenon should be replaced with cooler light sources.

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Section: Discussionmentioning

confidence: 99%

Prolonged intra-operative thermal exposure in endoscopic ear surgery: is it really safe?

et al. 2020

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“… 22 Endoscopes have the potential to cause thermal damage to middle ear structures, 23 but injury can be avoided by maintaining light intensity at 50%, using suction and irrigation for rapid cooling, keeping the endoscope tip at least 8 mm away from tissues, and removing the endoscope frequently. 24 , 25 , 26 …”

Section: Discussionmentioning

confidence: 99%

Heads-up Surgery

Ridge

Shetty

Lee

2021

Otolaryngologic Clinics of North America

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Synopsis A new era of surgical visualization and magnification is poised to disrupt the field of otology and neurotology. The once revolutionary benefits of the binocular microscope are now shared with rigid endoscopes and exoscopes. These two modalities are complementary. The endoscope improves visualization of the hidden recesses through the external auditory canal or canal up mastoidectomy. The exoscope provides an immersive visual experience and superior ergonomics compared to binocular microscopy. Endoscopes and exoscopes are poised to disrupt the standard of care for surgical visualization and magnification in otology and neurotology.

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“…Furthermore, the results for thermal spread from the tip of the endoscope and thermal distribution in human temporal bones may help in make EES practice as safe as possible. We might not need to use more power to obtain high-quality images as images taken during surgery by routine oto-endoscope at lower light intensities have no loss of quality (26), and future studies should investigate the light intensity applied during surgery and verify the functional consequences of the corresponding temperatures in an animal model.…”

Section: Discussionmentioning

confidence: 99%

Thermal Safety of Endoscopic Usage in Robot-Assisted Middle Ear Surgery: An Experimental Study

et al. 2021

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Objectives: The widespread application of endoscopic ear surgery (EES), performed through the external auditory canal, has revealed the limitations of the one-handed technique. The RobOtol® (Collin ORL, Bagneux, France) otological robotic system has been introduced to enable two-handed procedures; however, the thermal properties of dedicated endoscopes, which are usually used in neurosurgery, called “neuro-endoscopes,” have not yet been clarified for the robotic systems. In this study, we aimed to profile the thermal characteristics of two dedicated neuro-endoscopes, as compared to endoscopes used routinely in manual EES, called “oto-endoscopes,” and defined by a smaller diameter and shorter length, and to discuss the safe application of robotic assistance in EES.Methods: Two neuro-endoscopes (3.3 mm, 25 cm, 0°/30°) were studied using two routine light sources (LED/xenon), and two routine oto-endoscopes (3 mm, 14 cm, 0°/30°) were initially measured to provide a comprehensive comparison. Light intensities and temperatures were measured at different power settings. The thermal distributions were measured in an open environment and a human temporal bone model of EES. The cooling measures were also studied.Results: Light intensity was correlated with stabilized tip temperatures (P < 0.01, R2 = 0.8719). Under 100% xenon power, the stabilized temperatures at the tips of 0°, 30° neuro-endoscopes, and 0°, 30° oto-endoscopes were 96.1, 60.1, 67.8, and 56.4°C, respectively. With 100% LED power, the temperatures decreased by about 10°C, respectively. For the 0° neuro-endoscope, the illuminated area far away 1cm from the tip was below 37°C when using more than 50% both power, while this distance for 30° neuro-endoscope was 0.5 cm. In the EES temporal bone model, the round window area could reach 59.3°C with the 0° neuro-endoscope under 100% xenon power. Suction resulted in a ~1–2°C temperature drop, while a 10 mL saline rinse gave a baseline temperature which lasted for 2.5 min.Conclusion: Neuro-endoscope causes higher thermal releasing in the surgical cavity of ESS, which should be especially cautious in the robotic system usage. Applying submaximal light intensity, a LED source and intermittent rinsing should be considered for the safer robot-assisted EES using a neuro-endoscope that allows a two-handed surgical procedure.

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The effect of light intensity on image quality in endoscopic ear surgery

Abstract: Images taken during surgery by our endoscope and operative camera have no loss of quality when taken at lower light intensities. We recommend the surgeon considers use of lower light intensities in endoscopic ear surgery.

Cited by 14 publications

References 16 publications

Prolonged intra-operative thermal exposure in endoscopic ear surgery: is it really safe?

Prolonged intra-operative thermal exposure in endoscopic ear surgery: is it really safe?

Heads-up Surgery

Thermal Safety of Endoscopic Usage in Robot-Assisted Middle Ear Surgery: An Experimental Study

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