Original article ：Otoendoscopic treatment of hidden lesions in otomastoiditis

Background Surgical treatments for chronic suppurative and cholesteatoma otitis media have been discussed for several decades, but recurrences still occur because of the complex dissection required and hidden lesions associated with otomastoiditis. This study investigated the technology and strategy behind the use of otoendoscopic-assisted otosurgery. Methods We reported on hidden lesions in 32 ears of patients with otomastoiditis between November 2006 and January 2009. All the patients were treated with the aid of an otoendoscope. The advantages of otoendoscopy, including multi-angle light scattering, aperture illumination, and magnification of the local operative field, were utilized in otologic microsurgery, and otoendoscopic operative techniques were introduced for operative sites such as the epitympanum, aditus of the antrum, facial recess, sinus tympani and the mastoid tip. Results All patients were followed up from 3 months to 2 years after surgery. All patients recovered well within 3 months following surgery, except for one case of epithelialization of the mastoid cavity occurring 6 months after surgery for cholesteatoma on the cerebellar surface and another case with Bezold＇s abscess, hyperplastic granulation tissue developed at the antrum. Conclusions Otoendoscopy can overcome the technical deficiency of rectilinearity of the visual axis associated with otomicroscopic illumination, which presents a problem when dealing with otomastoiditis lesions in hidden areas. This technique allows such lesions within the complex three-dimensional structure to be visualized and cleaned. Otoendoscopy thus has significant potential for improving the quality of surgery and reducing the risk of postoperative recu rrence.

Results of pediatric endoscopic and endoscopically assisted tympanoplasty

Objectives:To evaluate the success of pediatric endoscopic and endoscopically assisted transcanal cartilage inlay tympanoplasty.Methods:Retrospective review of single surgeon experience.Results:During a 3 year period,30 children underwent 31 endoscopic or endoscopically assisted transcanal tympanoplasties by the senior surgeon using tragal cartilage/perichondrial inlay grafts.There were 22 boys and 8 girls,ranging in age from 3.5 to 17 years (median 6 years).All tragal cartilage grafts (31/31;100％) survived.Twenty-seven surgeries (27/31;82％) resulted in an intact drum (17/31;55％) or a microperforation (10/31;32％).In four cases (4/31;13％) significant perforations formed in previously unaffected portions of the drum.Conclusion:Transcanal endoscopic cartilage inlay tympanoplasty offers a practical,minimally invasive approach to tympanoplasty for children of any age.It avoids postauricular or endaural incisions,tympanomeatal flap elevation,and canalplasty.Graft survival is uniform.Microperforation at the graft margins remained in 1/3 of children.Technical modifications may lead to higher rates of tympanic closure.

Current trends and applications in endoscopy for otology and neurotology

There has been a rapid increase in endoscopic ear surgery for the management of middle ear and lateral skull base disease in children and adults over the last decade.In this review paper,we discuss the current trends and applications of the endoscope in the field of otology and neurotology.Advantages of the endoscope include excellent ergonomics,compatibility with pediatric anatomy,and improved access to the middle ear through the external auditory canal.Transcanal endoscopic ear surgery has demonstrated comparable outcomes in the management of cholesteatoma,tympanic membrane perforations,and otosclerosis as compared to microscopic approaches,while utilizing less invasive surgical corridors and reducing the need for postauricular incisions.When a postauricular approach is required,the endoscopic-assisted transmastoid approach can avoid a canal wall down mastoidectomy in cases of cholesteatoma.The endoscope also has utility in treatment of superior canal dehiscence and various skull base lesions including glomus tumors,meningiomas,and vestibular schwannomas.Outside of the operating room,the endoscope can be used during examination of the outer and middle ear and for debridement of complex mastoid cavities.For these reasons,the endoscope is currently poised to transform the field of otology and neurotology.