Microscopic Ear Surgery Research Articles

TEES-A New Horizon

Background: Transcanal endoscopic ear surgery has many advantages over conventional microscopic ear surgery and is used as adjunct to microscope or is used independently. Precise large visual field and angular vision has edge over the clumsy, expensive, peeping tubular vision of microscopes. Moreover, it is a better teaching methodology for the undergraduates and postgraduates. Our study comprised of twenty-five patients who had safe ear and underwent transcanal endoscopic ear surgery (TEES). Methods: This prospective study was carried out between October 2014 to December 2015 at Hayaat hospital, Allahabad, Uttar Pradesh, India and Hind Institute of Medical Sciences, Safedabad, Barabanki. Twenty-five patients of age group more than fifteen years were selected. All the patients selected had dry and safe type of chronic suppurative otitis media (CSOM). Results: Of the twenty five people ten were females and fifteen males in the ratio of 2:3. All the patients selected had dry ear and safe type of chronic suppurative otitis media (CSOM). All had conductive hearing loss of variable decibels but not greater than fifty-five decibels. Conclusions: Further research is needed in the field of operative TEES. We all need to discuss and more research work is needed to prove its genuinity and practicality.

Endoscopic ear surgery- acomplement to microscopic ear surgery.

Wullstein, the founder of modern microscopic ear surgery, already used an oto-endoscope intraoperatively. However, it is only after the recent development of modern video-endoscopy with high-definition, 4K, and 3‑dimensional imaging that endoscopically guided surgery of the middle ear is gaining some importance. Key ventilation routes like the isthmus tympani and the epitympanic diaphragm can be visualized far better using an endoscope than with a microscope. Going through the external meatus, surgery of middle ear pathologies is possible without external incision. This type of primary endoscopic ear surgery has to be distinguished from secondary endoscopic ear surgery, where standard microscopic ear surgery is supplemented by endoscopic surgery. Having to hold the endoscope in one hand, surgery has to be performed single-handedly, which is awkward. In cases of extensive bone removal or excessive bleeding, the view through the endoscope lens is obscured; therefore; the endoscope cannot fully substitute the microscope. It is, however, an interesting adjunct to microscopic ear surgery.

Supra-aural gossypiboma: case report of a retained textile surgical sponge in an unusual location

Gossypiboma or retained surgical sponge is an infrequently encountered surgical complication, more so in the head and neck region. A literature search did not reveal a previously reported case of retained or concealed surgical sponge after microscopic ear surgery. We present a unique and previously unreported case of a 25-year-old male who presented with a cystic swelling in the right supra-aural region 5 months post-modified radical mastoidectomy of the right ear. Surgical excision of the swelling revealed a retained surgical sponge. We emphasise the importance of counting surgical sponges after every surgical step to minimise the incidence of such retained surgical items.

Extending otology services to rural settings: Value of endoscopic ear surgery.

Introduction:Few centers, mainly located in urban settings offer otological surgical services, yet majority of patients requiring these services are rural based and are generally unable to access these centers with resulting disease chronicity and complications. This paper aims to describe the access of otological surgical services by a rural population.Methodology:This is a retrospective study of patients who accessed otological services at three secondary health institutions and one tertiary referral institution. All patients requiring ear surgery over a 4-year period were studied. The initial 2 years without ear endoscopic surgery was compared with the 2 years when ear endoscopic surgery was introduced. Hospital records were studied and relevant data were extracted.Results:Six hundred and nine ears required surgery over 4 years. Age ranged from 3 to 62 years, with a ratio of 1.4 males: 1 female. During the initial 2 years, all patients were referred from the three secondary health institutions to the urban-based tertiary institution for microscopic ear surgery, 94% failed to proceed on the referral. In the second 2 years, 34% were considered suitable for endoscopic ear surgery, of which 78% accepted and had surgery within the locality. Of the 66% referred, only 5% proceeded on the referral.Conclusion:With operator training and investment in portable ear endoscopy set, bulk of ear surgery needing magnification can be treated in the rural setting. This represents a most feasible means of extending the service to the targeted population.

Comparative Evaluation of IV Dexmedetomidine versus Dexmedetomidine with Butorphanol as an Adjuvant for Monitored Anaesthesia Care in Tympanoplasty and Myringoplasty: A Prospective, Controlled, Randomized, Double Blind Study

Background and Aims: It is a common practice to perform procedures like Tympanoplasty and Myringoplasty under Monitored Anaesthesia care (MAC). The recently introduced selective ?2 agonist dexmedetomidine, known for its opioid sparing effect along with sedative, analgesic hypotensive and anaesthetic properties with minimal respiratory depression has been used as a sole agent to provide MAC in various surgical interventions. The present study is aimed to evaluate the role of Dexmedetomidine as a sole sedoanalgesic agent and compare the efficacy of adding an adjuvant like Butorphanol to Dexmedetomidine. Material & Methods: 60 patients of either sex, aged 18-20 years, ASA grade I&II were randomized into two groups(D and BD) of 30 patients each for microscopic ear surgery under Local Anaesthesia(LA) with MAC. Group D received inj. Dexmedetomidine 1 mcg/kg iv loading dose while Group BD received inj. Dexmedetomidine 1 mcg/kg iv loading dose along with inj. Butorphanol 0.02 mg/kg. Both groups received an infusion of inj. Dexemetomidine @ 0.2 mcg/kg/hr. All patients were assessed for intraoperative haemodynamic changes, SpO2, respiratory rate, Ramsay sedation score(RSS), and visual analogue scale(VAS).Rescue doses of sedatives, analgesics, satisfaction scores(Patients and Surgeons) were compared in both the groups. Data was analyzed using chi-square and t-test. p value

The Efficacy of Color-Mapped Diffusion-Weighted Images Combined With CT in the Diagnosis and Treatment of Cholesteatoma Using Transcanal Endoscopic Ear Surgery.

To assess the efficacy of a color-mapped diffusion-weighted image combined with a computed tomography scan (CMDWI-CT) in preoperatively evaluating the anatomical location of cholesteatomas and determining whether a patient is indicated for transcanal endoscopic ear surgery (TEES) to reduce intraoperative switching to microscopic ear surgery (MES). Prospective case study. A single university hospital. Fifty-five patients scheduled for middle ear cholesteatoma surgery. The CMDWI-CT is produced in a multistep process. A color-mapped fusion image (CMFI) is created by performing MR cisternography on a 1-mm thin-slice nonecho planar diffusion-weighted imaging (non-EPI DWI) and then by performing color mapping on the resulting image to enhance cholesteatoma visualization. False positives are reduced by taking a T1-weighted image (T1WI), whereas false negatives are further reduced by preoperative endoscopic examination. As cholesteatomas are difficult to locate on a CMFI in the temporal bone region, we stripped out the MR cisternography data from the CMFI and then fused the CMFI to the initial computer tomography (CT) scan to create a CMDWI-CT. This CMDWI-CT better clarifies the cholesteatoma position within temporal bone. CMDWI-CT preoperative findings were compared with intraoperative findings. The positive predictive value and negative predictive value were also evaluated depending on the cholesteatoma location. CMDWI-CT facilitated accurate detection of the cholesteatoma anatomical location in the temporal bone region which was reflected in positive predictive and negative predictive values of over 90% for all areas of the middle ear. CMDWI-CT is a reliable diagnostic modality for evaluating the anatomical location of cholesteatomas that seem as high-signal regions on a CMFI and for determining whether TEES is indicated for treatment in such patients.

Tympanofacial Recess in the Human Ear

DESPITE great progress in microotology, accurate and thorough knowledge of the anatomy in certain operative areas has not yet been completely achieved. Variable anatomy creates situations that demand a full knowledge of the area. The surgical microscope, with its high magnifications, opens operative areas that demand familiarity with every millimeter of the magnified anatomy. One such area is a recess or sinus on the posteromedial wall of the middle ear cleft. An evolutionary ancient, it corresponds to the tympanic bulla of lower mammals.1Its true importance, however, lies in its proximal relations, the facial nerve, stapes in the oval window, the round window, and its little known proximity to the ampulla of the posterior semicircular canal. In middle ear disease and microscopic ear surgery, knowledge of the tympanofacial recess becomes essential. This provided the incentive to the present study. Materials and Methods Materials consisted of 24 right and left