Otoendoscopy - A New Horizon in Ear Surgery

Abstract

Introduction:-Middle ear surgery is usually performed with an operating microscope. Surgical eradication of cholesteatoma involves canal wall down or intact canal wall techniques. One of the important causes of failure is residual disease in the posterior tympanum specially the sinus tympani. Endoscopic intraoperative visualization of these regions and subsequent disease clearance has been demonstrated to reduce the recurrence of cholesteatoma in mastoidectomy. Objective:-To demonstrate the effectiveness of otoendoscopy along with microscopy vis-a-vis microscopy alone for disease clearance from the sinus tympani. Materials and Methods:-In this prospective study, a total of 40 ears with acquired cholesteatoma were operated upon between January 2012 and August 2013. Twenty three underwent Canal Wall Up (CWU) technique and rest (17) by canal wall down (CWD) procedure. Otoendoscopic evaluation was done after disease clearance of middle ear cleft by microscopy and remaining disease if any cleared. ResuIts:-There were five cases (12.5%) (three CWU mastoidectomy and two CWD mastoidectomy) in which the sinus tympani contained cholestatoma after clearance by microscopy. Otoendoscopy helped to clear remaining cholesteatoma completely in all cases. All patients were followed up for at least six months and no recurrence of cholesteatoma has been detected. So otoendoscopy assisted mastoid surgery provides 100% disease clearance in comparison to 87.5% disease clearance with conventional microsurgery alone. Condusion:-Otoendoscopy provides a panoramic view of the middle ear cavity and should be added to surgical armamentarium during mastoidectomy procedure for better disease clearance and surgical outcome. Keywords:-Otoendoscopy, ear, sinus tympani, cholesteatoma, canal wall up, canal wall down, microscopic surgery