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INVITED EDITORIAL
ENDOSCOPIC EAR SURGERY
THE FUTURE OF OTOLOGIC SURGERY ?
*Philip Rajan **Prepageran Narayanan
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DOI No.: 10.21176/ ojolhns.0974-5262.2016.10.1
3. Endoscopes used for sinus surgery, 4mm or 2.7mm bone and middle ear surgery can comfortably be
diameter (working length 14mm), can be used for used with the endoscope as well. However due to
ear surgery as well. While the 4mm endoscope differences in the techniques, instruments modified
offers an excellent view, the larger diameter makes or developed to complement endoscope use will
manipulation with an additional instrument in the provide a more comfortable surgical experience
ear canal difficult. The smaller 2.7mm diameter for the surgeon and better outcomes. Newer
scope suffers from some reduction in visual quality. technologies useful in endoscopic ear surgery
Endoscope manufacturers now produce a 3mm include piezoelectric bone dissection, lasers and
diameter (working length 14mm) scope which Quantum Molecular Resonance (QMR)
offers a balance between the advantages of the electrocautery.
conventional scopes. 6. Other issues that have been raised with endoscope
4. The endoscope is a hand held instrument, thus use are thermal damage from the endoscope light
endoscopic ear surgery has been described as a one and tissue damage from the endoscope tip.
hand procedure or technique as the surgeon has Published studies have reported it to be safe
only one free area to use for tissue manipulation provided good practice guidelines are adhered to.
while the other holds the endoscope. This creates The surgeon should be aware of optimal light
new challenges as well requires a change or settings and proper endoscope use.
modification of surgical techniques. Bleeding is a Most ENT surgeons today would have some
cumbersome issue with endoscopic ear surgery. familiarity using the endoscope as a diagnostic tool or
Blood can easily distort the surgical field. The for simple otologic procedures. However, as in
absence of two free hands makes hemostasis and Endoscopic Sinus Surgery education and training is
clearing the visual field more difficult. mandatory so that the surgeon understands the
5. Most microsurgical instruments used for temporal limitations and risks of using this instrument. The table
Table 1: Classification of Competence for Endoscopic Ear Surgery Procedures According to Experience* The
table is not exhaustive but describes the more common otologic procedures. The table divides a surgeons
capability in endoscopic ear surgery into 5 levels.
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DOI No.: 10.21176/ ojolhns.0974-5262.2016.10.1
below (Table 1) suggests the training and experience an or spaces. There is a cost factor which has to be
ENT surgeon should have before embarking on considered especially if newer and more precise
endoscopic ear surgery. equipment and instruments are used. A realistic
Most ENT surgeons should comfortably be able expectation of capabilities with the endoscope for
to perform Level I and II procedures, which are middle ear surgery cannot be overemphasised. Ground
confined to the external auditory canal and tympanic with this awareness and coupled with sound knowledge
membrane. The endoscope is an excellent instrument and experience will enable a surgeon to decide when
to visualise the middle ear cavity. Level III and IV and how to make optimal use of this instrument.
procedures require the surgeon to be flexible with the DISCLOSURES
use of both the endoscope and microscope to operate (a) Competing interests/Interests of Conflict- None
in the middle ear. Unexpected complications such as (b) Sponsorships - None ,
haemorrhage or extensive disease may require (c) Funding - None
conversion to the microscope. As such surgeons (d) No financial disclosures
performing these procedures should familiar with
REFERENCES
conventional microscopic techniques. Level V
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Exclusive endoscopic use in Level V procedures are a JF, Pothier D. Endoscopic transcanal ear anatomy
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One of the misconceptions trainees/junior ENT
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properties of operative endoscopes used in
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endoscopic procedure equates to safer, faster and
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easier, terms commonly attributed to minimally
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superior to conventional otoscopes or even microsopes
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when directly viewing the ear canal or middle ear. In
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technique is a skill which needs to be acquired.
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The concept of Functional Endoscopic Ear Surgery Spaces And Their Surgical Significance. J Laryngol
Vol.-10, Issue-I, Jan-June - 2016