Endoscopic Middle Ear Surgery: Tips and Pearls

Program Description: Middle ear surgery can generally be performed with the aid of an operating microscope. However, under a potentially minimally invasive trans-canal approach, it is very difficult to operate on several sites using a microscope alone unless the surrounding bone is removed and retro-auricular approaches are performed. Such sites may include the epitympanum as well as the inferior and posterior parts of the mesotympanum. Although it has been more than 15 years since the introduction of operative endoscopy to middle ear surgery there is still a very limited role for the endoscope in the surgical management of middle ear disease across the globe. There are several possible reasons for that, such as the current idea of a limited and marginal role for endoscopes in middle ear surgery, a potentially long learning curve through the hassles and tribulations of adapting newer techniques and newer instrumentation, and some resistance, especially with otologists who are very comfortable with the use of microscopes. The operating microscope provides a very good quality magnified image in a straight line, however, the surgeon’s field of view is limited to the narrowest segment of the ear canal when using a transcanal approach. On the other hand, endoscopes also provide a magnified vision that enables the ability to change rapidly from a close-up to a wide angle view, just by going closer or by withdrawing the instrument. Further, it provides an all-round vision to the surgeon who can rotate angled endoscopes to visualize the deep and hidden structures. In this miniseminar, we are going to discuss, with the help of very nice quality surgical movies, endoscopic anatomic dissection images and videos, virtual reality objects and also augmented reality capability the current techniques for endoscopic middle ear dissection, and surgical management of several middle ear diseases, such as tympanic membrane perforations, cholesteatomas, ossicular chain reconstruction and also stapedotomies, all performed with endoscopes discussing and commenting the equipment needed, surgical indications, also showing the potential advantages and disadvantages of the procedures, postoperative care and results and some interesting tips and pearls regarding this new way to surgically manage middle ear diseases. Educational Objectives: 1) Learn and review the endoscopic anatomy of the middle ear, discussing anatomic landmarks. 2) Identify the actual indications and limitations of this minimally invasive approach. 3) Describe and demonstrate step-wise endoscopic middle ear approaches for several diseases of this area.