Incorporating the Endoscope Into Middle Ear Surgery

Ent Ear Nose Throat Journal, 2006

We conducted a study to evaluate the use of a pediatric rigid otoendoscope for determining the extent of middle ear disease and for assessing ossicular integrity and mobility during tympanoplasty. Our study population was

Human Auditory System [Working Title], 2019

Endoscopic assistance is gradually gaining recognition in otology not only for office examinations but also during surgery. The first endoscopic surgical procedure that was started in our institution was endoscopic ventilation tube placement to manage children with stenotic and curved canals. Following this, endoscopy was used in all type I tympanoplasty and stage I cholesteatoma removals with the advantage of avoiding a postauricular or endaural approach. The last application of endoscopic assistance was to better visualize round window and scala tympani via posterior tympanotomy during cochlear implantation. There are several advantages in using endoscopes: the wide view obtained and the possibility to observe areas behind the angle with less invasiveness and its excellent resolution, in addition to its intense light and higher magnification that facilitates teaching and tutoring. The limits of endoscopic surgery are that one hand is always needed to hold the endoscope and the lack of a third dimension. Until miniaturization of 3D systems allow the possibility to work in the narrow external ear canal, in order to overcome the limitation that one hand is dedicated to the endoscope, we will describe the use of an endoscope holder in otologic procedures.

The Laryngoscope, 2015

Only a few reports describe the outcomes following endoscopic ear surgery (EES) in children for chronic ear disease. We differentiate between transcanal endoscopic ear surgery (TEES), where the case is performed with only endoscopic visualization, from non-TEES, where the endoscope is not used at all or used as an adjunct to the microscope. We hypothesize that EES is an effective approach to manage middle ear pathology using a transcanal approach in most cases, and can be incorporated into a pediatric otology practice with a neutral or positive effect on outcomes. Lessons learned during this process are analyzed and discussed. Single-institution, retrospective chart review of outcomes following TEES and non-TEES in children from January 1, 2013 through July 1, 2014. Procedures included tympanoplasty, ossiculoplasty, and cholesteatoma resection. Primary outcome measures included closure rate of tympanic membrane perforations, audiometric outcomes, and complications. Surgical times we...

2020

Background: Prolonged forms of otitis media (OM) lead to chronic hearing loss and disability from childhood. Wide spectrum of therapeutic approaches is used in management of OM in children. Objective evaluation of the middle ear after different curative modalities will help in analysis of treatment feasibility. The objective of this article was to compare the results of middle ear noninvasive monitoring after different surgical procedures in order to select the most effective one in prolonged otitis media forms. Material and methods: Patients represent 150 children with prolonged OM. Analyzed treatment modalities: I-myringotomy, II-classical tympanostomy, III-modified tympanostomy. Middle ear monitoring included otoscopy and audiometry what was repeated 4 times during 2 years, otomicroscopy in 1 and 2 years and impedance audiometry in 2 years after surgery. The quality of life and general health scores were analyzed before surgery and in 1 and 2 years after surgery. Results: Otoscopic and audiometric data showed stable improvement in 32% of children after myringotomy, 90% of children after classical tympanostomy and 97% of children after modified tympanostomy. Impedance audiometry in 2 years after surgery demonstrated complete restoration of middle ear function in 32% of children after myringotomy, in 78% of children after classical tympanostomy, and in 94% of children after modified tympanostomy. Conclusions: Post-surgical noninvasive monitoring demonstrated advantages of tympanostomy and especially in modified version: improvement and stability of middle ear function and low rate of otitis media persistence or recurrence.

International Journal of Pediatric Otorhinolaryngology, 2018

The feasibility of TEES in dealing with pediatric middle ear disease is still under investigation. The goal of this study was to compare anatomical dimensions of the EAC between children and adults, and to analyze the anatomic applicability of TEES in children. Methods: Forty pediatric (18 years old and younger) and 20 adult patients who received TB-HRCT to evaluate middle ear conditions were enrolled from December 2010 to December 2015. Dimensions including the diameters of the EAC orifice, isthmus and tympanic membrane annulus, the length of EAC, the height of the middle ear, and the angle between tympanic membrane and EAC axis were determined according to the TB-HRCT data. Results: The diameters of the EAC orifice and isthmus and length of EAC in the pediatric patients were slightly smaller than those in the adult patients. The anatomical dimensions of middle ear were similar in both groups. Simple regression analysis indicated that the diameters of the EAC orifice and isthmus and the length of the EAC were positively correlated with the age of the pediatric patients. In the pediatric patients, 67 ears (83.75%) had an EAC isthmus diameter larger than 4 mm and are sufficient with a 3-mm endoscope manipulation. Conclusion: TEES is applicable for most pediatric patients using an endoscope with a diameter of 3 mm or smaller. With an appropriate endoscope and instruments, TEES is a safe and effective alternative to treat pediatric middle ear disease.

2014

Middle ear surgery increasingly employs endoscopes as an adjunct to or replacement for the operative microscope. We provide a systematic review of endoscope applications in middle ear surgery with an emphasis on outcomes, including the need for conversion to microscope, audiometric findings, length of follow-up, as well as disease-specific outcomes. PubMed, Embase, and Cochrane CENTRAL database. A literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations. Articles were categorized based on study design, indication, and use of an endoscope either as an adjunct to or as a replacement for a microscope. Qualitative and descriptive analyses of studies and outcomes data were performed. One-hundred three articles met inclusion and exclusion criteria. Of the identified articles, 38 provided outcomes data. The majority of these studies were moderate quality, retrospective, case-series reports. The indications for use of the endoscope were broad, with the most common being resection of cholesteatoma. In cholesteatoma surgery, endoscope approaches routinely identified residual cholesteatoma in primary and second-look cases. Other outcomes, including robust audiometric data, operating room times, wound healing, and quality of life surveys were not well described. Endoscopes have consistently been used as an adjunct to the microscope to improve visualization of the tympanic cavity. Recent reports utilize the endoscope exclusively during surgical dissection; however, data comparing patient outcomes following the use of an endoscope to a microscope are lacking. Areas in need of additional research are highlighted. NA Laryngoscope, 2014.

American Journal of Audiology, 2005

Laryngoscope, 1992

Modern optical technology has made available fiberoptic and rigid endoscopes with diameters of 2 mm and less with acceptable resolution. Endoscopes of small caliber were introduced through a strategically placed myringotomy or an existing perforation to perform exploration of the middle ear as an in-the-office procedure. This technique is now routinely used as an adjunct in the diagnostic evaluation of patients with suspected middle ear conditions. Exploratory surgery of the middle ear may be avoided or definitive procedures may be planned better based on endoscopic findings.

PLOS ONE, 2015

Background The 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. Methods In 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. Results The patients were 15 years of age or older. The anatomical parts of the middle earthe epitympanic, posterior mesotympanic, and hypotympanic structureswere 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.

Praxis of Otorhinolaryngology, 2015

Bu çalışmada ossiküler fiksasyon veya devamsızlığın sıklığı, uygulanan cerrahi işlemler ve protez boyutları ile bunların odyolojik etkileri araştırıldı. Hastalar ve Yöntemler: Bu retrospektif çalışmaya kondüktif işitme kaybı olan ve etyolojinin keşfi için Haziran 2001-Mayıs 2015 tarihleri arasında ameliyat edilen 95 hasta (21 erkek, 74 kadın; ort. yaş 37 yıl; dağılım 11-67 yıl) dahil edildi. Hastalar ameliyat öncesinde ossiküllerin ve timpanik membran mobilitesinin tespit edilmesi için mikroskop ve pnömatik otoskop ile incelendi; işitme kayıplarının derecesi odyometri ile tanımlandı. Hastalar ameliyat sırasında ossiküler fiksasyon, dislokasyon, malformasyon ve diğer patolojik süreçler açısından değerlendirildi. Bulgular: Orta kulak patolojileri bakımından hastaların %63.1'inde normal ossiküler zincir, %29.4'ünde ossiküler devamsızlık, %55.7'sinde otosklerotik stapes fiksasyonu, %35.7'sinde skleroz ve hiyalin, %27.3'ünde mukozal köprü, %4.2'sinde anterior malleolar ligament kalsifikasyonları, %4.2'sinde fasiyal sinir dislokasyonu, %4.2'sinde ossiküloplasti geçmişi, %2.1'inde perilenf fistülü, %1.05'inde kolesteatom ve orta kulak hemanjiomu vardı. Ameliyat sırası komplikasyonların oranı %29.4 idi ve bunların %16.8'i timpanik membran yırtılmasını, %11.5'i korda timpani kopmasını ve %1.05'i ilaç alerjisini içeriyordu. Ameliyat öncesi saf ton ortalaması 59 dB hava kondüksiyonu, 23 dB kemik kondüksiyonu ve 36 dB havakemik aralığı gösterdi. Sonuç: Çalışmamızın bulgularında işitme kaybı düzeyleri, timpanogram tipleri ve orta kulak patolojisi tipleri arasında ilişki görülmedi. İşitme kaybının nedenleri otoskleroz ve ossiküler devamsızlık idi. Çoğu hastada fiksasyon veya devamsızlık gibi ossiküler disfonksiyon nedenleri ancak ameliyat sırasında tespit edilebilir. Anahtar sözcükler: İşitme kaybı; orta kulak; otoskleroz; timpanotomi. ABSTR ACT Objectives: This study aims to investigate the frequency of ossicular fixation or discontinuity, applied surgical procedures and prosthesis sizes, and their audiologic effects. Patients and Methods: This retrospective study included 95 patients (21 males, 74 females; mean age 37 years; range 11 to 67 years) with conductive hearing loss operated for exploration of etiology between June 2001 and May 2015. Patients were examined preoperatively with microscope and pneumootoscopy to determine ossicles and tympanic membrane mobility, and degree of their hearing loss was identified by audiometry. Patients were evaluated for ossicular fixation, dislocation, malformation, and other pathologic processes intraoperatively. Results: In terms of middle ear pathologies, 63.1% of patients had normal ossicular chain, 29.4% had ossicular discontinuity, 55.7% had otosclerotic stapes fixation 35.7% had sclerosis and hyaline, 27.3% had mucosal bridge, 4.2% had anterior malleolar ligament calcifications, 4.2% had facial nerve dislocation, 4.2% had previous ossiculoplasty, 2.1% had perilymph fistula, 1.05% had cholesteatoma and middle ear hemangioma. Rate of intraoperative complications was 29.4% including 16.8% for tympanic membrane tearing, 11.5% for chorda tympani severed, and 1.05% for drug allergy. Preoperative pure tone average revealed an air conduction of 59 dB, bone conduction of 23 dB, and air-bone gap of 36 dB. Conclusion: Our study findings showed no correlation between hearing loss levels, tympanogram types, and types of middle ear pathology. Causes of hearing loss were otosclerosis and ossicular discontinuity. Reasons for ossicular dysfunctions such as fixation or discontinuity may be detected intraoperatively in most patients.