9TH ENDOKL 2020 World Congress for ENDOSCOPIC SURGERY OF THE PARANASAL SINUSES SKULL BASE BRAIN AND SPINE 15TH- 18TH July 2020 Sangri-La Hotel Kuala Lumpur Malaysia- More Details

Endoscopic Ear Surgeries (Scarless or Holeless Ear Surgeries)

As a diagnostic and surgical tool the Hopkin’s rod nasal telescope (endoscope) in the nose and sinus areas have undergone marked revolution in the past 2 decades, so is the introduction of the telescope into Ear by the roaming newer generation ENT doctors.

Concept of Ear surgeries of my post graduate days (in nineties) are totally rubbish. Mastoidectomies are done for ear drum perforation without closure of the perforation – ridiculous .The ENT Heads & professors used to do mastoidectomies by chisel,Mallet and Lempert’s curettes. These caused only facial palsies and not disease removal – Inj. B-complex was quite popular at the end of mastoidectomies.

Then we (PGs) were asked to buy Dental Drills (Hanging motor) and to carry on every OT days (which would weigh between 6 to 10 Kgs) to do mastoidectomies. These drills caused lot of wobbling (like a wet Grinder) and heat to the holding fingers. Absolutely no sterlisation of the handpiece or cable.I was lucky to befriend some scrub nurses in Gen.surgical OT, so that I needn’t carry such a heavy one. Now all these have become ENT antique collection.

For all the CSOM with dry central perforation only mastoidectomies was done and hardly tympanoplasties was done. It is a pitty patients with a discharging ear drum hole coming for remedy, will have a mastoidectomy without repair of the hole and will continue to discharge in addition to the ugly postaural scar.

Then came the micro ear surgeries . Microscope were introduced to do middle ear work. You have to be VIP/rich enough to buy, carry the microscope bulb, use and remove at the end of the procedure. I had done some middle ear work by holding Palmistry magnifying Lens in the left hand and work with my right hand.That gave the idea to me and many to hold endoscope in one hand and operate with the other hand in the ear.

Temporalis fasia grafting the middle ear is must in all CSOM surgeries now, was considered a grave mistake in my learning days. It was like leaving the operated wound open without closing it by stitches.I still remember , a day once my ENT chief in MMC saw the temporalis fascia which I harvested and kept for grafting the ear drum hole, and asked me to throw into the dustbin saying that touching the middle ear or closing the eardrum hole causes sensorineural hearing loss. I am wondering how stupid it was !

Mastoidectomy patients will be discharged only after stitch removal (7th day).Now I discharge them within 24 hrs of the surgery. For stapedectomies PGs have to sit or squat around the surgeon ( ENT chiefs) to catch hold of the Teflon piston(implant) that silps and falls to the ground , like close in fielders for Kumble on 5th day of a test match. Still 5 to 10 pistons will be floored and wasted inspite of a good PG (like wicket keeper Dhoni) holding the head of patient preventing any shake.

Nowadays more and more Ear problems are treated endoscopically without leaving behind residual disease in the corners. The microcope is becoming obsolete gradually.

The following advantages were noted with Endoscopic Ear Surgery:








Disadvantages:

The only disadvantage noted was during drilling of mastoid when suctioning of the bone dust. One hand utilised to stabilise the endoscope , the other to hold the micromotor hand piece and drill with intermittent suctioning only possible.

When compared with conventional microscopic myringoplasy, the success rate is very high in endoscopic method. Added to this is the convenience and portability of the endoscope.

Formerly an operating microscope was used to perform myringoplasties. Recently with the common usage of nasal endoscope for nasal surgeries, we have started using it for most of the ear surgeries.