Endoscopic Tympanomastoid Surgery - Our Experience

Abstract

Introduction In last few decades medical science has seen resurgence of minimally invasive surgery by development of endoscopes with adequate illumination, magnification and image quality. Although operating microscope made a significant advance in ear surgery but it has a drawback of unobservable blind angles in cavities of middle ear. Objective To demonstrate the effectiveness otoendoscope along with operating microscope in tympanomastoid surgeries. Materials and methods In this prospective study conducted between January 2012 to January 2014, a total of 67 ears with chronic otitis media of mucosal and/or squamosal disease were operated. Twenty eight were operated using canal wall up (CWU) technique, 26 underwent canal wall down (CWD) surgery, 13 cases had tympanoplasty with endoscopic disease clearance .Intraoperative Otoendoscopic evaluation for disease clearance was done in all cases. Results Out of 28 CWU mastoidectomy, 21 cases had disease medial to incus & aditus, that was cleared completely with otoendoscopic assistance. Rest Seven cases had disease limited to attic & they underwent also had otoendoscopic disease clearance. Twenty six patients underwent CWD procedure with intraoperative otoendoscopic evaluation & clearance of residual disease. Thirteen cases undergoing tympanoplasty, which harboured disease in the middle ear also underwent cleared endoscopic clearance.We followed up all patients for at least 6 months and no recurrence has been detected. Conclusion Otoendoscope provides a panoramic view of middle ear cavity and endoscopic ear surgery preserves much of normal anatomy as possible by minimizing unnecessary dissection of bone & soft tissue. In addition there is more chances of ossicular preservation without jeopardizing disease clearance, hence it should be added to surgical armamentarium for better disease clearance and superior surgical outcome.

Keywords

• Ear, Middle/surgery
• Endoscopy/methods