The Treatment of Cholesteatomas Involving the Antrum and Mastoid Using Transcanal Underwater Endoscopic Ear Surgery

Chen, Yichao; Hu, Junjiao; Liu, Wei; Wang, Qin; Li, Yajun; Peng, Anquan; Zhang, Zhi-wen

doi:10.1097/mao.0000000000002813

Cited by 6 publications

(7 citation statements)

References 15 publications

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“…This technique is widely used to achieve efficient bone removal in TEES, where the surgical working space is limited. In underwater endoscopic ear surgery, continuous and safe cutting is possible while maintaining a clear field of view under water (16). In addition, underwater surgery is advantageous such that it can suppress overheating caused by drilling and facilitate working in watertight conditions, even when the membranous labyrinth is opened (17).…”

Section: Discussionmentioning

confidence: 99%

Experiences of Percutaneous Endoscopic Approach for the Mastoid Lesions: A Novel Minimally Invasive Ear Surgery

Uchida,

Morioka,

Mizutari

2024

Otol Neurotol

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Objectives We developed a novel keyhole surgery, named “percutaneous endoscopic ear surgery” (PEES), with the aim of further reducing the invasiveness of otologic surgery. We reported the cases we encountered and retrospectively analyzed the invasiveness of PEES. Methods We analyzed the ears of eight patients who underwent PEES for mastoid lesions that could not be manipulated with transcanal endoscopic ear surgery (TEES) at our hospital between July 2021 and November 2022. We performed PEES alone in three patients, including one case of type A (preauricular incision) and two cases of type B (retroauricular incision). The last five patients underwent combined endoscopic ear surgery, which is simultaneous PEES and TEES. In these cases, one patient underwent type A PEES, and four patients underwent type B PEES. Results PEES was performed in all patients without converting to conventional microscopic mastoidectomy. The mean length of skin incisions was 19.1 ± 4.5 mm, which was smaller than that in conventional mastoidectomy. In all cases, the average length of the major axis of the keyhole was <10 mm, indicating that sufficient minimally invasive surgery was achieved. The average depth from the keyhole to the deepest site was 21.6 ± 8.9 mm. There was no change in the mean hearing level before and after the surgery. Conclusion PEES is a minimally invasive procedure for manipulating lesions in the mastoid. In addition, the combination of PEES and TEES is an ideal, minimally invasive procedure that can be used to treat all regions of the temporal bone.

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Section: Discussionmentioning

confidence: 99%

Experiences of Percutaneous Endoscopic Approach for the Mastoid Lesions: A Novel Minimally Invasive Ear Surgery

Uchida,

Morioka,

Mizutari

2024

Otol Neurotol

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“…Although these reports stated that the field of view could be obtained by endoscopic surgery, we believe that in many cases, this is not sufficient. Concerning drilling EAC, we, alongside other institutions, have reported atticotomy or antrotomy in TEES using curved bur [ 25 – 27 ], and a similar technique can be performed for drilling anterior overhang.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic tympanoplasty type I using interlay technique

Takahashi

Motegi

Yamamoto

et al. 2022

J of Otolaryngol - Head & Neck Surg

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Background Tympanoplasty using the interlay technique has rarely been reported in transcanal endoscopic ear surgery, unlike the underlay technique. This is because many surgeons find it challenging to detach the epithelial layer of the tympanic membrane using only one hand. However, the epithelial layer can be easily detached from the inferior part of the tympanic membrane. Another key point is to actively improve anteroinferior visibility even if the overhang is slight because most perforations and postoperative reperforations are found in the anteroinferior quadrant of the tympanic membrane. We report the application of the interlay technique in endoscopic tympanoplasty type I for tympanic perforations. Methods We retrospectively reviewed the medical records of 51 patients who had undergone tympanoplasty using the interlay technique without ossiculoplasty between 2017 and 2020. We then compared the data with those of patients who underwent microscopic surgery (MS) using the underlay technique between 1998 and 2009 (n = 104). No other technique was used in each group during this period. Repair of tympanic membrane perforation and hearing outcomes were assessed for > 1 year postoperatively. Results The perforation sites were limited to the anterior, posterior, and anterior–posterior quadrants in 23, 1, and 27 ears, respectively. Perforations were closed in 50 of the 51 ears (98.0%), and the postoperative hearing was good (average air-bone [A-B] gap was 6.8 ± 5.8 dB). The surgical success rate for the repair of tympanic membrane perforation was not significantly different from the MS group (93.3%, P = 0.15). The average postoperative average A-B gap in the group that underwent the interlay technique was significantly different from that in the MS group (10.1 ± 6.6 dB, P < 0.01). Conclusion The interlay technique should be considered as one of the treatment methods in endoscopic surgery for tympanic perforations. Further study of the postoperative outcomes of this procedure should be conducted to establish the optimal surgical procedure for tympanic perforations. Trial registration: This study was retrospectively approved by the Institutional Review Board of the Jikei University, Tokyo, Japan (approval number: 32-205 10286). Video abstract

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“…As in type II, the tympanic segment can be directly visualized in type III nerves, avoiding nerve injury during atticotomy. In addition, if continuous irrigation is applied during surgery, 11 the obscuration of bleeding on the surgical field can be better avoided. With continuous irrigation, the surgeon may elevate the tympanic annulus and more clearly identify the chorda tympani nerve, which may be more beneficial for protection of the nerve (Video 1 ).…”

Section: Discussionmentioning

confidence: 99%

Variation and protection of the chorda tympani nerve in endoscopic ear surgery

Jiangtao

Chai

2022

Laryngoscope Investig Oto

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Objective To observe and summarize variations of the chorda tympani nerve to effectively protect it during surgery. Methods Surgical videos of patients undergoing endoscopic ear surgery in the past 3 years were retrospectively observed to identify chorda tympani nerve variations. Results In total, 237 cases were reviewed. The tympanic sulcus or annulus was the boundary between the posterior wall of the external auditory canal and chordal eminence (CE). The chorda tympani nerve was divided into three types: type I, the periannular segment was located medial to the CE and covered by the bony eminence (32.5%); type II, the periannular segment was located inferior to the CE, and the nerve did or did not contact the bony edge of the CE (62.0%); and type III, the periannular segment was located lateral to the CE and medial to the tympanic annulus, and the iter chorda posterius was located in the tympanic sulcus (5.5%). The rate of injury to the chorda tympani nerve was 2.5% of 237 cases. The location of the iter chorda posterius on preoperative computed tomography was highly reliable for prediction of type I and III nerves. Secondary exposure of the posterior canaliculus might occur in patients with external auditory canal cholesteatoma, who were specifically included in this study. Conclusion CE‐based classification of the chorda tympani nerve can concisely describe variations of the chorda tympani nerve and provide guidance for neuroprotection during endoscopic ear surgery. Patients with external auditory canal cholesteatoma may have secondary exposure of the posterior canaliculus. Level of Evidence NA.

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The Treatment of Cholesteatomas Involving the Antrum and Mastoid Using Transcanal Underwater Endoscopic Ear Surgery

Cited by 6 publications

References 15 publications

Experiences of Percutaneous Endoscopic Approach for the Mastoid Lesions: A Novel Minimally Invasive Ear Surgery

Experiences of Percutaneous Endoscopic Approach for the Mastoid Lesions: A Novel Minimally Invasive Ear Surgery

Endoscopic tympanoplasty type I using interlay technique

Variation and protection of the chorda tympani nerve in endoscopic ear surgery

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