To evaluate whether a computer vision model can utilize monocular endoscopic images of the middle ear to generate three-dimensional (3D) surface reconstructions that register to ground-truth (GT) imaging with clinically acceptable accuracy for surgical navigation. Eight temporal bone phantoms derived from the publicly available OpenEar data set were 3D-printed. Middle ear endoscopy was performed in each model using a standard monocular otologic endoscope, and a single endoscopic image captured of the mesotympanum. Images were processed with a monocular surface reconstruction model to generate predicted 3D surface reconstructions. Reconstructions were registered to GT meshes using natural anatomic landmarks. Surface reconstruction error (SRE) was quantified using the mean modified Hausdorff distance, and target registration error (TRE) was calculated using withheld test fiducials. Mean SRE across models was 0.58 ± 0.10mm, with 81.6% of points within 1mm of GT surfaces. Mean TRE was 0.96 ± 0.17mm. Simple 2D, monocular endoscopic images can be converted into high-fidelity 3D surface reconstructions of middle ear anatomy, which can be registered to ground-truth imaging with submillimeter registration accuracy. These findings establish the preclinical feasibility of monocular, endoscope-centric navigation for transcanal endoscopic ear surgery.

Clinical relevance of the new classification for mastoid progression in the staging and classification criteria for middle ear cholesteatoma proposed by the Japan Otological Society.

Proportion of middle ear surgeries feasible via transcanal endoscopic ear surgery: A multicenter study in Japan.

Objective:To analyze the application experience and operation result of continuous irrigating mode of otoendoscopic surgery in patients with lateral semicircular canal fistula as a complication of cholesteatoma, so as to provide a basis for the feasibility and safety of the operation. Methods:A total of 45 patients diagnosed with middle ear cholesteatoma who underwent transcanal endoscopic surgery in our department between November 2022 and March 2025 were enrolled, among whom 13 presented with labyrinthine fistula. Mastoid opening and lesion removal were performed in continuous irrigating mode, patients with labyrinthine fistula underwent external semicircular canal fistula repair and tympanoplasty were completed at the same time, and outpatient re-examination was performed at 1 week, 3 weeks, 8 weeks and 12 weeks after surgery, of which endoscopic examination was performed at 3 weeks, 8 weeks and 12 weeks after surgery, and pure tone hearing threshold test was performed 6 months after surgery. Thereafter, regular re-examinations will be conducted every 3 to 6 months. The operation time, preoperative and postoperative vertigo symptoms, changes in bone conduction threshold of pure tone auditory threshold, the time of postoperative dry ear and surgical cavity epithelialization were analyzed. Results:A total of 13 patients were collected, all of whom had external semicircular canal fistulas, including 5 males and 8 females, aged 21 to 77 years, with a mean age of （47.62±15.40） years, with lesions located on the left side in 7 cases, 6 cases on the right side, 6 cases of type Ⅰ fistula and 7 cases of type Ⅱ fistula.The average operation time was（164.77±12.77） min, There was no statistically significant difference in the operation time compared with patients without labyrinth fistula（155.13±9.15） minutes（P=0.563）. 11 cases（84.62%） had dry ears 3 weeks after surgery, 9 cases（69.23%） reached cavity epithelialization at 8 weeks after surgery, and all cases reached epithelialization at 12 weeks after surgery. There was no statistically significant difference in the average bone conduction threshold before and after the operation（P=0.064）, and the average air-bone conduction difference was statistically significant（P=0.012）. One patient had vertigo symptoms after surgery, which was relieved 1 week after surgery, and the bone conduction hearing threshold of this patient did not change compared with that before surgery. Conclusion:①Continuous irrigating mode in otoendoscopic surgery provides a clear surgical field and allows for safe lesion removal, with operation times comparable to those in patients without labyrinthine fistula. ②No significant postoperative decline in bone conduction hearing thresholds was observed, while the air-bone gap was significantly improved. ③The low incidence of postoperative vertigo, along with shorter time to dry ear and cavity epithelialization, suggests that transcanal endoscopic surgery with continuous irrigation is a safe and effective approach for managing labyrinthine fistula.

Innovations in paediatric cholesteatoma surgery.

Background Chronic suppurative otitis media (CSOM) is a significant global health concern, leading to persistent ear discharge and hearing loss. Aims/objectives This study aimed to evaluate the clinical efficacy and safety of EES for CSOM and to identify independent prognostic factors influencing surgical success. Materials and methods In this single-center retrospective cohort study, 180 patients undergoing EES for CSOM between 2022 and 2024 were enrolled. Data on demographics, clinical profiles, and surgical details were collected. Primary outcomes included dry ear rate, pure-tone average (PTA) improvement, and complications at 6 months post-surgery. Results The 6-month dry ear rate was 91.1%. Mean PTA improved significantly by 24.8 ± 7.2 dB. The complication rate was 3.9%. Multivariate analysis identified cholesteatoma (HR = 3.24, 95% CI: 1.85–5.68, p < 0.001), disease duration >5 years (HR = 2.52, 95% CI: 1.45–4.38, p = 0.001), and preoperative PTA >50 dB (HR = 2.89, 95% CI: 1.65–5.06, p < 0.001) as independent risk factors for failure. Subgroup analyses confirmed the consistency of these factors. Conclusions and significance Endoscopic ear surgery is an effective and safe treatment for CSOM in the mid-term (6-month) follow-up. Cholesteatoma, prolonged disease duration, and severe preoperative hearing loss are robust predictors of poorer outcomes.

Evaluation of the feasibility and surgical applicability of the ENDOFIXexo robotic endoscope holder (AKTORmed) in various ear, nose, and throat (ENT) procedures. This study was conducted as a prospective single-center feasibility study involving 26 patients who underwent endoscopic ENT surgery between September 2022 and May 2025. The ENDOFIXexo system was used as a passive robotic assistant. The study assessed surgical performance, intraoperative handling, system limitations, and safety outcomes. The device provides stable endoscopic visualization and allows truly bimanual operation in multiple procedures. It is particularly beneficial for orbital decompression, dacryocystorhinostomy, eustachian tube balloon dilation, and endoscopic ear and laryngeal surgeries. Nonetheless, its application is limited to narrow nasal cavities and highly hemorrhagic procedures. No adverse events were observed, and the setup time remained below 10 minutes. The ENDOFIXexo is a safe and practical tool with the potential to enhance the quality of endoscopic ENT surgery by strongly facilitating bimanual techniques. Its utility is highly valuable in complex or assistant-limited procedures. However, further studies are necessary to strengthen these findings.

Background: Cholesteatoma is a destructive middle ear lesion that compromises hearing and quality of life, for which endoscopic ear surgery (EES) has emerged as a minimally invasive alternative to microscopic approaches. While recurrence and audiological outcomes are frequently reported, patient-centered evaluations using validated patient-reported outcome measures (PROMs) remain limited. Objective: This study aimed to assess postoperative quality of life in patients undergoing exclusive endoscopic cholesteatoma surgery, using validated patient-reported outcome measures. Methods: We conducted a prospective observational cohort study in a tertiary referral center, enrolling 41 patients who underwent exclusive endoscopic cholesteatoma surgery over 20 months. Pre- and postoperative QoL was assessed using the Chronic Otitis Media Questionnaire-12 (COMQ-12) and the Glasgow Benefit Inventory (GBI). Results: COMQ-12 scores improved significantly from baseline (54.0 ± 4.2) to 12 months (10.2 ± 3.3; mean difference -43.8, 95% CI: -46.1 to -41.5; p < 0.001). GBI scores were consistently high, increasing from 82.6 ± 4.8 at 6 months to 84.1 ± 4.9 at 12 months (p < 0.001). Audiometric evaluation demonstrated a significant postoperative improvement, with the mean air-bone gap (ABG) decreasing from 52.1 ± 5.3 dB preoperatively to 26.4 ± 4.7 dB postoperatively (p < 0.001), indicating substantial closure of the conductive gap. Conclusions: Exclusive endoscopic cholesteatoma surgery yields robust QoL improvement, favourable hearing outcome, and recurrence rates similar to classic techniques at short-term evaluation.

Clinical trials on cochlear gene therapy for patients with autosomal recessive deafness 9 through transcanal and transmastoid approaches were reported in 2024. While both are clinically feasible in older patients, the small size of the external auditory canal (EAC) in younger patients may limit the applicability of transcanal endoscopic approaches. Therefore, we aimed to evaluate pediatric EAC anatomy by using temporal bone computed tomography (CT). Retrospective study. Tertiary center. Children aged 0 to 18 years. We analyzed 624 temporal bone CT scans obtained between 2017 and 2024. Measurements included the full, bony, and cartilaginous lengths of the posterior and inferior EAC walls, angle between the inferior EAC wall and tympanic membrane, diameter at the narrowest point of the EAC, and tympanic membrane diameter, all assessed using a standardized method. The full and bony lengths of the inferior EAC wall, the angle between the inferior EAC wall and tympanic membrane, and the diameter at its narrowest point increased dramatically between 0 and 1 year of age. During this period, the annual increases in these measurements were 2.21mm, 8.59mm, 33.0 degrees, and 1.43mm, respectively. In contrast, the tympanic membrane diameter remained unchanged throughout childhood. The feasibility of transcanal endoscopic ear surgery depends on the diameter at the narrowest point of the EAC, the endoscope and surgical instrument dimensions, and the length of the bony part of the EAC needed to elevate a tympanomeatal flap. Based on our findings, a transmastoid microscopic approach should be considered instead of transcanal approach in patients under 1 year of age.

Ear surgery has historically been performed with a microscope, an approach which often requires a post-auricular incision and represents a relatively invasive form of access to the middle ear. Over the past three decades, the advent of endoscopic techniques has allowed for a minimally invasive alternative. Endoscopic ear surgery (EES) has emerged as an innovative approach in otology, transforming the way surgeons address ear disorders and improving patient outcomes. EES provides enhanced visualization and exceptional precision during otologic procedures. This article examines the technical aspects of EES, its impact on contemporary otology practice, and the future direction of this technology.

Middle ear osteomas are extremely rare benign tumors of the temporal bone and are most commonly associated with conductive hearing loss due to ossicular chain involvement. We report the case of a 24-year-old female who presented with left-sided hearing loss, intermittent otalgia, and taste disturbance. Radiological evaluation revealed a well-defined bony lesion within the middle ear. The patient was treated successfully using an endoscopic transcanal approach. Histopathological examination confirmed the diagnosis of osteoma. Postoperative audiometry demonstrated marked hearing improvement. This case highlights the rarity of middle ear osteomas and emphasizes the effectiveness of endoscopic ear surgery as a minimally invasive treatment option.

To evaluate the clinical indications, surgical techniques, audiological outcomes, operative efficiency, and safety of underwater endoscopic ear surgery (UWEES). A comprehensive literature search was conducted through 14 May 2025 using PubMed, Google Scholar, and the Cochrane Library. Keywords included "endoscopic ear surgery," "underwater ear surgery," and "endoscopic underwater ear surgery." Original English-language studies involving UWEES in human subjects (≥ 3 patients) were included. Studies using microscopes or conducted in animals were excluded. Data extraction and quality assessment were performed independently by two reviewers, following PRISMA guidelines and using the NIH tool for risk of bias in case series. A qualitative synthesis was conducted due to heterogeneity in study designs and outcomes. Nine studies met inclusion criteria. UWEES was applied across five principal indications: canaloplasty, attic cholesteatoma, cholesteatoma involving the mastoid, labyrinthine fistula repair, and superior semicircular canal dehiscence (SCDS) plugging. Across all studies, sensorineural hearing was preserved, with significant improvements in air-bone gap closure. Operative time was reduced compared to traditional methods. UWEES was associated with low complication rates and effective resolution of vestibular symptoms in > 90% of cases. UWEES is a safe, effective, and minimally invasive technique offering enhanced surgical visualization, improved hearing outcomes, and better inner ear preservation. Further prospective, high-quality studies are needed to validate their long-term efficacy and establish standardized protocols.

To analyze the efficacy of tympanoplasty for severe tympanosclerosis under the continuous irrigation mode. Retrospective. First Affiliated Hospital of Wenzhou Medical University. Patients with severe tympanosclerosis involving critical anatomic structures (eg, stapes footplate, facial nerve canal, vestibular window niche). Tympanoplasty with continuous irrigation mode. Saline irrigation to reduce bleeding, improve surgical continuity, and shorten operative time. Removal of calcified lesions and ossicular chain reconstruction. Surgical efficacy (assessed by completeness of lesion removal and hearing improvement), operative time, frequency of endoscope withdrawal for cleaning, complication rates (including facial paralysis, vertigo, sensorineural hearing loss, and taste disturbances), tympanic membrane healing status, chorda tympani preservation rate, and feasibility in overcoming traditional limitations (eg, single-handed operation, bone drilling difficulties). Reduced intraoperative bleeding. Improved procedural continuity. Shortened operative time. Enhanced feasibility for complex lesions (eg, near facial nerve). Postoperative outcomes improved with reduced complication rates. The continuous irrigation mode represents a safer and more effective advancement in tympanosclerosis surgery, addressing limitations of conventional endoscopy by improving efficiency and reducing complications. Further clinical validation is needed.

BackgroundTranscanal endoscopic ear surgery (TEES) is becoming increasingly popular in otologic surgery and can be considered the first choice for stapes surgery. In this study, we analyzed a case series of TEES for stapes surgery, focusing on the estimation of appropriate prosthesis length using preoperative CT based on postoperative hearing results.MethodsWe retrospectively examined 31 patients who underwent TEES using a rigid endoscope for stapes surgeries. Postoperative hearing results were good in 27 cases (87.1%) and poor in four cases (12.9%). We reviewed the preoperative CT scans of all the patients and measured the straight-line distance from the incudostapedial joint to the oval window in the coronal images, assuming it to be the estimated appropriate prosthesis length (eAPL).ResultsThe actual length of the prosthesis inserted during the operation was shorter than the eAPL in three of the four cases without postoperative hearing improvement. In the remaining patients, postoperative CT indicated that the prosthesis position was inadequate.ConclusionThe measurement of the APL using preoperative CT could contribute to improving postoperative hearing outcomes after stapes surgery using TEES.

Background: In Otolaryngology, impressive innovations in diagnostic, minimally invasive procedures, implantable hearing devices, endoscopic and robotic surgery, image guidance, biologics, and AI-enabled decision support continue apace. However, the availability of evidence throughout the technology life cycle is uneven; often strongest for development/validation and weaker for real-world impact, health technology assessment (HTA) and implementation. Objective: The goal is to synthesise important advances in diagnostic and therapeutic technologies related to ear, nose and throat disorders and to collate evidence using a life-cycle framework (Preparation ? Development ? Validation, Software Application ? Impact Assessment ? Implementation). Data Sources: The synthesis of evidence was performed based on landmark studies, clinical practice guidelines, pivotal randomised trials, systematic reviews/meta-analyses and selective regulatory/implementation literature throughout audiology, rhinology, laryngology, head and neck oncology and sleep medicine. Review Methods: Through PRISMA-style logic for transparency of evidence sourcing and a life-cycle-based evidence mapping approach that illustrates where evidence is strong vs limited (eg, implementation planning, monitoring, and HTA), a structured narrative review was developed. Results: Progress in diagnostics involves techniques like auditory brainstem response (ABR), otoacoustic emissions (OAE), diffusion-weighted MRI for cholesteatoma, narrow-band imaging (NBI) for laryngeal lesions and FEES for dysphagia. Head and neck cancers may benefit from PET-CT strategies. Therapeutic advances comprise of endoscopic ear surgery, endoscopic sinussurgery and balloon dilatation, eustachian tube balloon dilation, biologics for chronic rhinosinusitis with nasal polyps (CRSwNP), cochlear implant and bone-conduction systems, transoral robotic surgery (TORS), office-based laryngeal procedures, hypoglossal nerve stimulation for obstructive sleep apnoea (OSA), transoral endoscopic thyroidectomy vestibular approach (TOETVA). It was stated that even though diagnostic accuracy of AI applications in otoscopy and laryngoscopy is promising, its reporting and implementation are inconsistent. Conclusions: Technologies that are ear, nose and throat specific are improving patient outcomes but widespread adoption is lacking complete evidence across all cycles and even impact assessment and monitoring.

Stapes surgery has evolved from stapes mobilization to stapedotomy, which was initially performed using a surgical loop and is now done using an operating microscope. The improvement of endoscopic systems is attributed to the advancement of optical and medical engineering technologies, and has made endoscopic ear surgery a popular choice for various middle ear surgeries. In particular, endoscopic stapes surgery (ESS) has an advantage over the conventional microscopic stapes surgery (MSS) because it provides a wide-angled and magnified view of the middle ear structures, including the stapes, during surgery. All stapes surgical procedures can be performed exclusively using the transcanal endoscopic approach. Moreover, the postoperative hearing outcomes of ESS are comparable to those of conventional MSS. However, being a one-handed procedure with a steep learning curve, ESS can be an alternative to the conventional MSS, provided that the surgeon understands the advantages and disadvantages and is properly trained.

Abstract Introduction Hundreds of studies have been conducted on the overall success of endoscopic ear surgery over the traditional microscopic technique, prompting further usage of the endoscope. Endoscopic technique gives a wider scene and simple investigation of concealed areas surrounding the angles in the middle ear, minimizing recurrence rates compared to approaches using only microscopes. Furthermore, no needs for the postauricular or endaural incisions with the endoscopic tool. On the other hand, those newly introduced tools have a number of drawbacks can be summarized in the inability to use the two hands, possibility of mechanical and thermal damages, and the difficulty of handling bleeding within the narrow middle ear field. Those difficulties can be overlooked by adequate learning programs and gaining experiences. Objectives This study of the literature focuses on all the disadvantages concerned with the use of endoscopes in ear surgery by freshly educated physicians and provides solutions described in the literature to enhance the learning curve ensuring patient safety and improving clinical outcomes. Data synthesis I performed a literature search of medical databases, including MEDLINE, PubMed and Google Scholar, and was expanded to other search engines including Springer link, Science Direct and Wiley Online Library to find out relevant articles. The search terms used were as follows: endoscopic ear surgery, microscopic ear surgery, advantages, handicaps, learning curve, otology and middle ear surgery. I evaluated the results of these searches and excluded articles and documents that were not pertinent or were redundant. I focused my review on studies involving difficulties associated with the exclusive endoscopic ear surgeries for the newly trained physicians and how to overcome those difficulties and enhances their learning curve. Conclusion Endoscopic Ear Surgery has a steep learning curve and several disadvantages. However, with skilled and well-trained hands, all of the mentioned handicaps may be easily overcome.

Suction Irrigation Synergy: Optimization of Single Handed Endoscopic Ear Surgery

This study aimed to evaluate physical simulation models for endoscopic ear surgery including model types, validation methodology and educational outcomes. A Preferred Reporting Items for Systematic reviews and Meta-Analyses compliant search of PubMed, Embase and the Cochrane Library was conducted to June 2025. Studies describing physical endoscopic ear surgery simulators with reported validation or educational outcomes were included. Fourteen studies met inclusion criteria. Simulators comprised cadaveric animal heads, synthetic task trainers and single- and multi-material three-dimensional-printed models. Face validity was consistently high. Construct validity, assessed using Objective Structured Assessment of Technical Skills scores or timed tasks, was demonstrated in five studies. Content validity was reported in three studies. No study evaluated transfer validity. Educational outcomes included improvements in confidence, anatomical knowledge and task completion time. Physical endoscopic ear surgery simulators show strong face validity and emerging construct validity, but evidence is limited by small, single-centre studies and methodological variability. Standardised validation and assessment of clinical transfer are needed to support integration into training pathways.

Objective:To introduce a new design of super-micro flap for endoscopic ear surgery, and to evaluate the application effect of super-micro flap in endoscopic tympanoplasty. Methods:Between January, 2023 and March, 2024, 58 patients（64 ears） with tympanosclerosis underwent tympanoplasty with super-micro flap. Continuous irrigating mode endoscopic ear surgery（CIM-EES） was used to complete type Ⅱ or Ⅲ tympanoplasty with the tragus cartilage with followed up for 12 to 24 months. The operation time, postoperative efficacy and complications were statistically analyzed. Results:Of the 64 ears, 63 ears had primary healing of the tympanic membrane, and 1 ear had cartilage necrosis due to multi-drug resistant bacteria infection. The second operation was performed one year later, and the success rate of operation was 98.40%. The average operation time was （48.40±8.86） minutes. The average hearing threshold of 0.5 kHz to 4.0 kHz before operation was （59.63±10.62） dB HL, and the average air conduction threshold of 0.5 kHz to 4.0 kHz one year after operation was（38.79±10.91） dB HL, which was significantly improved compared with that before operation（P<0.01）. Bone conduction threshold also improved significantly （24.49±8.55） dB HL vs（21.88±7.58） dB HL（P<0.01）. No outer tympanic membrane healing and ear canal scar stenosis occurred. Conclusion:The design of super-micro flap can effectively solve the interference of flap floating during continuous irrigating mode in endoscopic ear surgery, relieve the difficulty of flap reposition, simplify the operation process, help to shorten the operation time, and reduce the possibility of circular scar stenosis of conventional free flap, which provides a new flap design option for endoscopic ear surgery.