Transtympanic Endoscopy of the Middle Ear (original) (raw)
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Incorporating the Endoscope Into Middle Ear Surgery
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 made up of 132 patients who were undergoing surgery for the treatment of chronic suppurative otitis media; of this group, 41 patients underwent otoendoscopy and 91 underwent scutum lowering for purposes of visualization. In the otoendoscopy group, the ossicles were successfully visualized and their mobility assessed in 34 patients; the remaining 7 patients subsequently underwent scutum lowering. A 30 degrees endoscope allowed for complete visualization of the middle ear in almost all of the 34 cases. The mean duration of surgery for the 34 patients in the otoendoscopy group was 62.85 minutes (+/- 15.57), which was significantly shorter than the duration of surgery (71.23 +/- 15.65 min) for the 98 patients who underwent scutum lowering (p < 0.005). A total of 50 ...
Incorporating endoscope in 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
[Endoscopic anatomy of the middle ear]
Lin chuang er bi yan hou ke za zhi = Journal of clinical otorhinolaryngology, 2002
To provide a detailed anatomic description of middle ear endoscopy via different approaches. Using 0, 30 and 90 degree rigid endoscopes, 6 dry temporal bones and 11 temporal bone blocks were examined to define the average range of view obtained by three approaches: 1. via the external ear canal approach; 2. via a retroauricular incision: including two subdivided routes, the mastoid-tympanic antrum route and mastoid-retrotympanum route; 3. via the middle ear cranial fossa. Each region of the middle ear was chosen for inspection. 1. via the external ear canal approach, all sites of the tympanic cavity structures were seen with 0, 30 and 90 degree rigid otoendoscopes, including the hidden areas such as the tympanic sinus, facial recess, anterior epitympanic recess, orifice of eustachian tube et al. 2. via the mastoid-tympanic antrum route, the structures of the mastoid cavity, tympanic antrum, epi-mesotympanum were clearly defined; via the mastoid-retrotympanum route, the structures of...
Ear endoscopic surgery: dissection of the middle ear
Intl Arch Otorhinolaryngol, 2009
Introduction: The endoscope is an equipment used successfully in several procedures of several medical specialties. However, in the otology area, even with incorporation of endoscopes in joint procedures with microscope, the procedures purely assisted by endoscopy are still very limited. Objective: Our work is aimed at carrying out transcanal and modified transcanal endoscopic dissection of the middle ear, by showing important anatomic marks, as well as the structures that may be viewed through this access. Type of Study: Prospective Methods: In May 2009, 10 parts of temporal bones were dissected by the same surgeon with the help of endoscopes. We used instruments from 0 to 45 grads and 4 mm, the same that were applied in nasosinusal surgeries. Results: There was no major technical difficulty performing dissections. We could identify several key-structures such as incudo-malleolar articulation, tympanic segment of the facial nerve, lateral semi-circular canal and additus ad antrum, all without provoking lesions in the middle ear structures. Conclusion: The middle ear endoscopic dissection by transcanal and modified transcanal ways is possible and enables an excellent view of important structures in the middle ear. The ear surgery techniques with endoscope are currently similar to the microscopic ones, but some instrument adaptation, new techniques and familiarization with such appliances are critical for the future procedures.
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.
Instrumentation and Technologies in Endoscopic Ear Surgery
Otolaryngologic Clinics of North America, 2013
The operating microscope requires wide viewing portals for adequate illumination and visualization of the operative field, contrary to the endoscope, which provides direct vision with illumination to the target field, thus avoiding the need for extra exposure and extra drilling. When planning an exclusive endoscopic ear surgery, still the microscope is an essential part of the surgical setting making it ready to use whenever needed. Combining the attributes of microscope and endoscope during surgery is the most efficacious approach. Cholesteatoma resection is considered complete only after a final survey with the angled endoscopes is completed, confirming absence of pathologic conditions from all hidden recesses. The principal advantage of aspiration instruments is the ability to perform dissection and aspiration maneuvers at the same time overcoming the impact of operating with one hand as imposed by otoendoscopic surgery. The main limit of instruments with suction channels is the possibility of occlusion caused by detritus aspirated during dissection.
Systematic review of outcomes following observational and operative endoscopic middle ear surgery
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.
Endoscopic Ear Surgery: A Scoping Review / Cirurgia Endoscópica De Ouvido: Uma Revisão Do Escopo
2021
INTRODUCTION: Endoscopic surgery has gained notoriety among otologists in recent decades thanks to the enhancement of potential surgical methods and to the significant volume of scientific publications on the subject. AIM: The present literature review was carried out in order to assess endoscopic ear surgery research available in the literature, its main surgical indications, as well as advantages and disadvantages. METHODS: The present literature review was based on the term Endoscopic Ear Surgery; 385 articles were selected as its basis. RESULTS: 326 (84.6%) of the 385 selected articles were published in 2011, 37 (9.6%) of them were published between 2001 and 2010, and 22 (5.8%) up to 2000. According to these articles, 17664 endoscopic ear surgeries have already been performed, either as entire surgical procedures or just for microscopic assistance purposes. Tympanoplasty accounts for the largest number of ear surgeries, it is followed by cholesteatoma surgeries (either via transcanal tympanoplasty or mastoidectomy). Endoscopic surgery advantages include reduced cholesteatoma recurrence, less mastoidectomy procedures, shorter operating room time and costs, less postoperative pain, better visualization of middle ear structures, minimally invasive procedures and less second-look surgeries. Its disadvantages include required healthy external auditory canal, single-handed surgical procedures and thermal effects of endoscopy. CONCLUSIONS: Endoscopic ear surgery has been acknowledged as a promising surgical method by otolaryngologists. Although it has faced some resistance from surgeons who have previously mastered micro-ear surgery, this surgical method has already been regarded as a point of no return.
Analysis of middle ear morphology for design of a transnasal endoscope
2019
Cholesteatomas are benign lesions that form in the middle ear (ME). They can cause debilitating side effects including hearing loss, recurrent ear infection and drainage, and balance disruption. The current approach for positively identifying cholesteatomas requires intraoperative visualization either by lifting the ear drum or transmitting an endoscope through the ear canal and tympanic membrane – procedures which are typically done in and operating room with the patient under general anesthesia. We are developing a novel endoscope that can be inserted trans-nasally and could potentially be used in an outpatient setting allowing clinicians to easily detect and visualize cholesteatomas and other middle ear conditions. A crucial part of designing this device is determining the degrees of freedom necessary to visualize the regions of interest in the middle ear space. To permit virtual evaluation of scope design, in this work we propose to create a library of models of the most difficu...