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ENT
Endoscopic Ear Surgery
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
9 sections · 124 slides
Overview
- Scope of this presentation
Rationale for endoscopic ear surgery
- Binocular microscopy as the traditional optic
- Approaches developed to overcome line-of-sight limits
- Historical development of otologic endoscopy
- Current range of endoscopic otologic procedures
- Advantages of endoscopic visualization
- Angled endoscopes and access around corners
- Hidden compartments of the middle ear cleft
- Ergonomic and educational advantages
- One-handed surgery as the core limitation
- Loss of binocular depth perception
- Anatomical limit at the lateral semicircular canal
- Endoscopic versus microscopic ear surgery
Equipment and operating room setup
- Rigid endoscope specifications
- Selection of angled endoscopes
- Instrumentation for single-handed dissection
- Tympanomeatal flap elevation
- Patient and equipment positioning
- Operating room arrangement for endoscopic ear surgery
- Light intensity and thermal safety
- Structures at risk from endoscope tip heat
- Preparation of the external auditory canal
- Sequence of endoscopic canal preparation
Endoscopic tympanoplasty
- Indications for endoscopic tympanoplasty
- Preparation of the perforation edge
- Ship sail tympanomeatal flap design
- Flap elevation and access to the middle ear
- Lateral to malleus underlay technique
- Graft materials for underlay tympanoplasty
- Lateral to malleus underlay tympanoplasty
- Indications for the overlay technique
- Vascular strip design
- Elevation of canal skin and drum layers
- Canalplasty and drilling parameters
- Graft placement in the overlay technique
- Anterior sulcus packing and prevention of blunting
- Outcomes of endoscopic type 1 tympanoplasty
- Outcomes of endoscopic lateral graft tympanoplasty
- Comparative advantages in tympanoplasty series
- Interlay technique and iatrogenic cholesteatoma
- Randomized within-patient comparison
- Chronic otitis media without cholesteatoma
- Pediatric endoscopic tympanoplasty
- Summary of the tympanoplasty evidence
Cholesteatoma surgery
- Access problem posed by middle ear cholesteatoma
- Conventional microscopic options and their morbidity
- Role of the endoscope in limited cholesteatoma
- Selection by extent of cholesteatoma
- Exposure and atticotomy technique
- Ossicular chain handling by cholesteatoma site
- Inspection for residual keratin
- Reconstruction after cholesteatoma removal
- Recidivism after endoscopic cholesteatoma surgery
- Reduction in mastoidectomy rates
- Predictors of residual and recurrent disease
- Limitations of current follow-up data
- Operative time, pain and cost of conversion
- Cholesteatoma section conclusions
Ossicular chain reconstruction
- Indications for endoscopic ossiculoplasty
- Optical advantages for ossicular reconstruction
- Preparation and assessment of the ossicular chain
- Gelfoam platform for prosthesis placement
- Placement of a partial ossicular replacement prosthesis
- Ossiculoplasty with a partial ossicular prosthesis
- Placement of a total ossicular replacement prosthesis
- Ossiculoplasty with a total ossicular prosthesis
- Audiometric outcomes of endoscopic ossiculoplasty
- Larger series and the air bone gap
- Interpretation of the ossiculoplasty evidence
Stapes surgery
- Challenges of endoscopic stapes surgery
- Principal advantage in stapes surgery
- Common steps before fenestration
- Prosthesis measurement and stapedotomy fenestra
- Sequence of endoscopic stapedotomy
- Microdrill use under endoscopic view
- Endoscopic stapedotomy
- Stapedectomy technique
- Risks specific to stapedectomy
- Audiometric outcomes of endoscopic stapes surgery
- Dysgeusia and other reported advantages
- Malleostapedotomy in congenital stapes malformation
Lateral skull base and middle ear tumours
- Expansion of the endoscope to the lateral skull base
- Traditional approaches to vestibular schwannoma
- Evolution of the transpromontory approach
- Patient selection for the transpromontory approach
- Initial exposure in the transpromontory approach
- Limits of dissection in transpromontory access
- Cochlear drilling and exposure of the canal
- Tumour removal and closure
- Transpromontorial resection of a vestibular schwannoma
- Facial nerve outcomes after transpromontory resection
- Future relevance of the transpromontory approach
- Case selection for glomus tympanicum resection
- Exposure for glomus tympanicum resection
- Degloving for protympanic tumour extension
- Devascularization and haemostasis
- Glomus tympanicum resection
- Outcomes of endoscopic glomus tympanicum resection
- Petrous apex cholesterol granuloma: access options
- Infracochlear endoscopic technique
- Outcomes after endoscopic petrous apex drainage
Conclusions
- Effect of the endoscope on middle ear understanding
- Current status of total endoscopic ear surgery
- Take-home points
- References
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- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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