Endoscopic Ear Surgery
Our ear and hearing mechanism is composed of several parts. The external ear is composed of the auricle (outer ear) and the ear canal that ends at the eardrum. Sound is funneled into the ear canal and vibrates the eardrum. The middle ear extends from the eardrum to the oval window of the inner ear and contains the three hearing bones (malleus, incus, stapes). The middle ear transfers the sound waves in the air collected by the auricle and ear canal and transfers it into the fluid filled inner ear. Ear disease often originates from the eardrum or within the middle ear itself. Visualization of this anatomic nature is very difficult, though technologies have significantly improved our ability to assess and treat these conditions.
Microscopes have been utilized in ear surgery since the 1960’s. The development of these microscopes revolutionized ear surgery techniques. Massive improvements have been made over the years in both optical and lighting technology. The view during microscopic surgery is defined and limited by the narrowest segment of the ear canal. This limitation can make surgery of the middle ear and mastoid challenging in some cases. The following images demonstrate the use of an operating microscope and the corresponding view of the ear drum achieved.
More recently, advances in endoscopic technology have occurred, allowing the incorporation of this technology into ear surgery. Use of endoscopes in ear surgery allows your surgeon to bypass the narrow segment of the ear canal and provides a wide view of the middle ear. These endoscopes enable your surgeon to look behind bony ledges and “around the corner”, ensuring the best possible outcome for surgery. The use of endoscopes allows your surgeon to visualize structures in the middle ear and mastoid that may not be visualized using the microscope. The following images demonstrate the use of the endoscope and the corresponding view of the ear drum achieved.
Uses of Endoscopic Ear Technology:
During surgical removal of cholesteatoma, it is critical that all disease is removed from the middle ear and mastoid. If some of the skin cells associated with cholesteatoma are not visualized and eliminated, recurrence of the disease may occur and cause further problems. There are poorly visualized areas of the middle ear that most often harbor residual cholesteatoma. The attic area above the middle ear, the Eustachian tube, and the sinus tympani are the most common of these areas. Using an endoscope, we are able to more fully assess and treat these areas, ensuring that cholesteatoma is not “hiding” from our view. This lowers the chance that cholesteatoma persists and recurs. The following images demonstrate a microscopic view of a cholesteatoma compared to the endoscopic view. The microscopic view on the left shows the back of the ear drum is collapsed onto the floor of the middle ear. The endoscopic view on the right shows extension into the retrotympanum.The stapes, the round window, and the sinus tympani are revealed to be involved with cholesteatoma.
A second procedure after the cholesteatoma resection may be recommended to ensure that no residual disease is present and also to rebuild the hearing bones, when necessary. Utilizing endoscopic middle ear technology, we are often able to perform these procedures through the ear canal without making any external incision. The endoscope allows us to visualize the entire middle ear cavity through a small access procedure. The image on the left represents a microscopic view of a middle ear in which residual disease is suspected to be absent. One can just visualize the head of the stapes. The image on the right shows an endoscopic view of the same view, assuring the surgeon of complete absence of residual disease.
Use of the endoscope to obtain intraoperative photos has improved the quality and usefulness of the images for training and educational purposes. Our surgeons utilize the endoscope to document intraoperative findings both for patient education and to assist in long term follow up. A variety of methods are used to rebuild the ear drum and hearing bones. The following images document a few techniques used in middle ear surgery. Otosclerosis, stapes piston placement, cartilage tympanoplasty, and ossicular reconstruction are seen here.