Systematic review of outcomes following observational and operative endoscopic middle ear surgery

Abstract

Objective Middle ear surgery increasingly employs endoscopes as an adjunct to or replacement for the operative microscope. Superior visualization and transcanal access to disease normally managed with a transmastoid approach are touted as advantages with the endoscope. No study, however, has systemically reviewed the literature to evaluate outcomes of endoscopic ear surgery (EES). We provide a systematic review of endoscope applications in middle ear surgery with an emphasis on outcomes. Data Sources PubMed, Embase, and Cochrane Methods A literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations. Articles were categorized based on study design, indication, and use of an endoscope either as an adjunct to or as a replacement for a microscope. Quantitative and descriptive analyses were performed. Results Ninety-one articles published between 1967 and 2014 met inclusion and exclusion criteria. The main indication for the use of an endoscope was cholesteatoma or myringoplasty. Of the identified articles, 40 provided a discrete discussion of outcomes. In cholesteatoma surgery, the endoscope has been mainly employed as an adjunct to the microscope, and although outcomes assessments vary across studies, the endoscope identified residual cholesteatoma in up to 50% of cases. Conclusion Endoscopes have been predominately used as an observational adjunct to the microscope to improve visualization of the tympanic cavity. Recent reports utilize the endoscope exclusively during surgical dissection; however, data comparing patient outcomes following the use of an operative endoscope versus a microscope are lacking. Areas in need of additional research are highlighted.

Cutting Edge Technologies in Otology Field

“…Endoscopic sinus surgery has become the first-choice treatment modality in the treatment of nasal cavity diseases and it is expanding its coverage in the areas including skull base, head & neck region and temporal bone. Although endoscopic middle ear examination was firstly introduced in the 1960s, there has been much controversy about the use of endoscopy in the otology practice [1,2].…”

“…Thus, bleeding control might be difficult compared to microscopic ear surgery. Likewise, surgical procedures under endoscopy are more likely to have a gradual learning curve [2]. In addition, there are two major issues of safety concerns in TEES.…”

“…Recently, feasibility of TEES as a microscope replacement has been proposed by demonstrating the safety of TEES without significant complications in both adult and pediatric patients [11]. In addition, TEES does not have the morbidity associated with a post auricular incision and TEES has a short recovery time [2]. It is expected that endoscopic ear surgery will be applied to various otologic disease in the future, because surgical instruments and techniques are continuously being developed and the number of otologists who are gradually familiar with endoscopic surgery is increasing.…”

“…There has been much progress in the field of otology. Recently, endoscopic ear surgery technique has expanded the application and scope of the technique [1,2]. The development of information technology (IT) also affects medical education systems.…”

Minimally Invasive Transcanal Removal of Attic Cholesteatoma

“…Besides surgeries for cholesteatoma removal, an exclusively endoscopic approach during tympanoplasty has been applied to facilitate minimally invasive surgery [16,17].…”