Different Details on Endoscopic and Microscopic Eardrum Surgery
Endoscopic and Microscopic Eardrum Surgery
Why is Endoscopic Eardrum Surgery Preferred?With the help of endoscopic eardrum surgeries, which are becoming more and more common recently, the holes in the eardrum can be closed with the help of an endoscope placed in the external ear canal without making a visible skin incision. Middle ear surgery is usually performed using a surgical microscope. Initially used in otorhinolaryngology, endoscopes for paranasal sinus surgery
In fact, incision of the tympanic membrane through the outer ear canal has been done from the outset. Transcanal myringoplasty or transcanal tympanoplasty can be performed with the help of both microscope and endoscope. Endoscopic tympanic membrane repair operation is an ideal procedure for repairing simple eardrum holes in the ears which are described as roughly "clean - dry ears", which do not have chronic inflammation in the middle ear and no inflammation in the bones in the middle ear. The cartilage, cartilage membrane, or both, which can only be removed after a 1 cm skin incision in the anterior portion of the auricle, can be used to repair the hole in the eardrum during the procedure.
In general, the reasons why patients prefer endoscopic eardrum surgery can be listed as follows:
• there is no visible incision at the back of the ear or in front of the ear
• little change in ear anatomy
• be simple and can be done in a short time
• can be easily reproducible.
As in other surgical fields, there is a tendency towards minimally invasive intervention in the field of otorhinolaryngology. Small incisions made under the guidance of endoscopes are preferred according to conventional large incisions. Using this approach, better results can be obtained and postoperative morbidities can be reduced. In addition, the results of grafts using an endoscopic approach are similar to those obtained with a microscopic approach. Therefore, endoscopic ear surgery applications are becoming increasingly popular (source link >> Endoscopic tympanoplasty - ScienceDirect). Initially it was used to visualize only the middle ear. They were then used in addition to microscopes during all surgical procedures involving the middle ear and were eventually used as independent instruments (source link >> History of the Endoscopic Ear Surgery). Microscopes require image adjustment during operation, while forward and reverse movements of the endoscope can easily produce close-up and angled images when necessary. Furthermore, the rotational movement of the angled endoscopes may provide panoramic views of the deep and hidden regions of the middle ear.
Advantages of endoscopic eardrum surgeryEndoscopic approach is a less invasive approach since it does not require incision or canalplasty (external ear extension and reshaping process) and there is no need for hair transplantation for the treatment of hair loss which may occur in the ear area incision site, there is no risk of scoop ears due to the incision made behind the auricle There are many advantages like.
Compared to the microscopic approach, the endoscopic approach is associated with less postoperative bleeding and pain and results in better cosmetic results.
Endoscopic Eardrum Surgery is Not Suitable for Every Patient!Endoscopic repair of the tympanic membrane is ideal for selected patients, patients with a hole in the eardrum of the head. It is not an appropriate method for chronic middle ear infections with cholesteatoma and chronic ears with chronic inflammation. It would be more appropriate for you to leave the technical selection on this subject to the physician who examined you. Patients with very narrow external canal may not be very suitable.
Contraindications of endoscopic eardrum surgeryEndoscopic technique is not appropriate to repair the membrane "nastoid containing large middle ear cholesteatoma, obstruction of the external ear canal which prevents endoscopic access and the presence of exocytosis, inadequate equipment availability" (source links >> Ear endoscopic Surgery: Dissection of the Middle Ear).
Endoscopic Technique of Membrane Repair Can Be Performed "Without Touched The Outer Ear Canal" in Patients With Curled External Ear Canal "
The pleated anatomy of the external ear and bone protrusions adversely affect the microscopic appearance and impair the visualization of deep structures. In such cases, canalplasty may be required. On the other hand, the panoramic and wide angle views obtained by the forward and reverse movements of the endoscope are not affected by the curved anatomy of the external ear canal. The vision beyond the end of the endoscopy is readily available to the surgeon, which can also be enlarged by various endoscope manipulations, which eliminates the need for a channel plate. (source link >> Endoscopic tympanoplasty vs microscopic tympanoplasty in tubotympanic CSOM: a comparative study of 44 cases).
Loss of depth perception and a hand technique are some of the disadvantages of the endoscope that can be overcome by application. Therefore, endoscopic tympanoplasty may be a good alternative to microscopic tympanoplasty.
Endoscopic Eardrum Operation Can Also Be Performed In Patients Who Underwent Previously Unsuccessful Eardrum Surgery!As in the above animation photograph, in the patients who have already undergone an eardrum operation and have small holes or holes in the eardrum, an endoscopic repair of the tympanic membrane can be performed.
Are Special Tools and Surgical Material Required for Endoscopic Eardrum Surgery?Unlike conventional tympanic membrane surgery, endoscopic myringoplasty or endoscopic tympanoplasty operations can be performed without using a microscope. In other words, the endoscopic system is used instead of the microscope. In addition, the use of the endoscope which is to be placed in the outer ear canal in the form of a thin and possibly short-sized "pediatric endoscope" may allow other instruments to be placed in the external ear path during the operation.
Which Ear Surgeries Can Be Performed By Endoscopic Method?Endoscopic technique is not only for tympanic surgery; ventilation tube placement, myringoplasty, tympanoplasty, ossicle reconstruction for malformation and ossicular trauma, cholesteatoma operations, otosclerosis surgeries and cochlear implantation procedures may also be preferred (source >> Endoscopic management of cholesteatoma: long-term results).
Tympanoplasty includes treatment of the middle ear disease, repair of the hole eardrum and hearing restoration. Endaural, transcanal and postauricular approaches are used during myringoplasty and tympanoplasty. Recently, transcanal endoscopic approaches have become popular. The endoscopic approach provides a much wider field of vision. In the microscopic approach, the retroauricular approach is preferred in the anterior perforations (in the anterior perforation of the eardrum), while the posterior perforations are preferred in the enaural approach, whereas the small holes are usually treated with a transcanal approach. The main advantage of the microscopic approach is that it allows the surgeon to work with two hands and also provide a view of depth perception. (source link >> The effects of the incision types in myringoplasty operations...).
About Endoscopic and Microscopic Eardrum Surgery
Disadvantages of Endoscopic Eardrum Surgery According to Microscopic Eardrum SurgeryEndoscopic eardrum surgery requires the surgeon's mastery of anatomical detail and experience with ear surgery. In general, the endoscopic technique of tympanic membrane surgery can be classified as follows (source link >> Endoscopic Ear Surgery - Thieme Connect):
• Performing surgical manipulations with one hand
• Because the monitor provides two-dimensional views, the depth perception is difficult
• During the process, the dirt on the outer ear canal and the small amount of blood from the ear can easily be affected and the need to clean the endoscope tip frequently
• External ear canal requires good hemostasis
• Although this issue is controversial, it is argued that "the endoscope could potentially damage the environmental structures caused by the heat generated from the light source". The cold light source is already used during the process and the end of the endoscope is not exposed to the structures in the middle ear.
• Endoscopes are limited in magnification
• Requires training
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