Otoendoscope assisted ear surgery

Endoscopic examination of the middle ear cleft visualizes whole tympanum and the ear canal from multiple angles without any need to manipulate the patients head or the microscope. Endoscope allows the surgeon to visualize the middle ear completely and to simultaneously check the ossicular continuity and mobility. The present study was conducted for a period of one year in 70 patients who were admitted for surgical management of tubotympanic CSOM (safe type), atticoantral CSOM (unsafe) and secretory otitis media. Regarding safe type of CSOM cases, in endoscopic group it was observed that in 95% cases post operative AB Gap was less than 20db as compared to only 5% pre operatively and in microscopic group it was observed that in 85% post operative AB Gap was less than 20db as compared to only 5% pre operatively. Regarding unsafe type of CSOM cases, in 3 (37.5%) patients out of 8 patients, cholesteatoma left inadvertently after microscopic canal wall down mastoidectomy surgery was identified and removed by otoendoscope from sinus tympani and anterior attic area. Similarly in 2 (40%) patients out of 5 patients cholesteatoma left inadvertently after microscopic canal wall down surgery was removed from sinus tympani, anterior attic and protympanum. No cholesteatoma remnants left inadvertently were observed by otoendoscope in 2 patients of microscopic atticotomy. Overall incidence of cholesteatoma observed and removed from hidden areas by endoscope was 33.3% thus defining the importance of otoendoscopy in cholesteatoma surgery. Overall pre-operative AB-Gap was more than 41db recorded in 13 (86.7%) patients on PTA. Post-operative AB-Gap was reduced by 10 db in 10 (66.7%) patients. Endoscopic myringoplasty was found to be equally effective and less morbid. Endoscope assisted surgery allows a better understanding of cholesteatoma and improved eradication of residual/recurrent disease from hidden areas such as facial recess, sinus tympani, anterior epitympanic space, protympanum and hypotympanum than with conventional microscopic surgery alone. Grommet insertion can be done effectively using otoendoscope.