Ovine Endoscopic Ear Surgery - Accessible Smartphone-Based Training Model

Background: Understanding middle ear anatomy, in addition to endoscopic surgical skill acquisition, is an arduous task. Mastering 3-dimensional conceptualization and surgical dexterity may take many years. The coronavirus pandemic has made training difficult and complicated due to social distancing and risk of aerosolized viral spread in cadaver dissection. In this study we suggest a smartphone-based endoscope ovine head cadaveric dissection which is a simple, safe, and affordable training model for residents as an initial step in otologic endoscopic surgery training.Methods: A stepwise depiction of endoscopic ovine middle ear surgery; from cadaver and equipment acquisition, setting preparation, to surgical explanation and procedural steps. Results: The smartphone-based endoscopic otological ovine dissection model provides a low-cost, easily accessible and easily deployable training model for the novice surgeon world-wide. This model permits the novice surgeon a comprehensive anatomical understanding, middle ear proprioception, as well as a "safe" practicing model for diverse middle ear procedures. Conclusions: The ovine cadaver otological smartphone-based endoscopic surgery training model is an affordable, easy, reproducible, and transportable model, which makes it an ideal model from implementation in both low-middle and high-income countries.

Revision Stapedotomies: the Role of Periprosthetic Scar Tissue Formation in the Development of Unsatisfactory Hearing Results after Stapedotomy

Introduction Revision stapes surgeries are difficult to perform, and their audiological results are inferior to primary surgeries. Objective Our goal was to identify the most common and most influential postoperative reasons that cause persistent air-bone gap (ABG) after the primary surgery. Our focus was concentrated on the mechanical dysfunctions in the middle ear, with special regard to postoperative adhesion formation. Methods We performed a retrospective case series study with 23 cases that underwent revision stapedotomies. Results A significant improvement was seen in ABG and air conduction levels after surgery. The periprosthetic adhesion formation was seen in 65% of the cases, and it was the primary cause behind the unsatisfactory hearing result in 30% of cases. There was no significant difference in the level of persistent ABGs after the primary surgery, in case of the intratympanic adhesion presence, compared with the presence of other surgical failures. Concerning hearing and ABG gain after revision surgery, the non-inferiority of the negative effect associated with adhesion was shown compared with the other reasons. Conclusion The revision stapedotomy is an efficient treatment option in case of persistent ABG. Periprosthetic adhesions are the most common intratympanic reasons for compromised audiological outcomes after stapedotomy.Adhesion formations have the same negative effect on ABG development as any other surgical failure, and the revision could be more challenging in these cases. These findings highlight the use of the most atraumatic surgical technique and preservation of intact intratympanic mucosa during middle ear surgery.

A comparative study of endoscopic assisted versus conventional middle ear and mastoid surgery at a tertiary care teaching hospital

<p><strong>Background:</strong> Objectives were to compare outcomes, intra operative visualization and operative time duration in endoscopic assisted vs conventional middle ear and mastoid surgery.</p><p><strong>Methods: </strong>This prospective comparative study was conducted in 50 patients; among them 25 cases were of endoscope assisted middle ear surgery and 25 cases with conventional microscopic middle ear surgery. A 4 mm diameter, 18 cm long rigid, zero-degree endoscope and operating microscope was used. Primary outcomes include mean average pre and post operative air-bone (A-B) gap, hearing thresholds, intra operative visualization and duration of surgery.<strong></strong></p><p><strong>Results: </strong>Mean A-B gap closure for endoscopic assisted tympanoplasty was 12.76±6.00 dB, while it was 8.38±5.78 dB for non-endoscopic assisted tympanoplasty. The results were comparative. Mean intra-operative time duration for endoscopic assisted tympanoplasty was 70.23±4.17 min, while it was 77±9.80 min for non-endoscopic assisted tympanoplasty with statically significant difference between both groups (p=0.03). Graft uptake rate for endoscopic assisted tympanoplasty was 92.31% while it was 84.62% for non-endoscopic assisted tympanoplasty. Residual cholesteatoma remnant on endoscopy was found in 43.66% cases out of 12 mastoidectomy cases performed via endoscopic assistance.<strong></strong></p><p><strong>Conclusions: </strong>The endoscope can be successfully applied to ear surgery for most of the ear procedures with a reasonable success rate both in terms of perforation closure and hearing improvement and with minimal exposure. Wide-field zero, 30 or 70° endoscope sallow visualization of hidden anatomic spaces and working around corners i.e., epitympanum, hypotympanum and retro tympanum for safe removal of cholesteatoma.</p>

Improved visualization of the chorda tympani nerve using ultra‐high-resolution computed tomography

Background Recognition of the anatomical course of the chorda tympani nerve (CTN) is important for preventing iatrogenic injuries during middle-ear surgery. Purpose This study aims to compare visualization of the CTN using two computed tomography (CT) methods: conventional high-resolution CT (C-HRCT) and ultra‐high-resolution CT (U-HRCT). Materials and methods We performed a retrospective visual assessment of 59 CTNs in normal temporal bones of 54 consecutive patients who underwent both C-HRCT and U-HRCT. After dividing CTN into three anatomical segments (posterior canaliculus, tympanic segment, and anterior canaliculus), two neuroradiologists scored the visualizations on a four-point scale. Results On C-HRCT, the visual scores of the posterior canaliculus, tympanic segment, and anterior canaliculus were 3.5 ± 0.7, 1.6 ± 0.6, and 3.1 ± 0.7, respectively. The respective values were significantly higher in all segments on U-HRCT: 3.9 ± 0.2, 2.4 ± 0.6, 3.5 ± 0.6 ( p < 0.01). Although the difference in scores between methods was greatest for the tympanic segment, the visual score on U-HRCT was lower for the tympanic segment than for the anterior and posterior segments ( p < 0.01). Conclusion Ultra‐high-resolution CT provides superior visualization of the CTN, especially the tympanic segment.

Inlay butterfly versus underlay cartilage tympanoplasty

Background Tympanic membrane grafting is one of the most common otological procedures. Underlay technique of tympanoplasty was described by Shea in 1960. Utech in 1959 introduce the cartilage in middle ear surgery. The search for an ideal graft material and technique for tympanoplasty was adopted by numerous contributions from surgeons all over the world. Professor Roland Eavey in 1998 introduced a transcanal inlay technique which offers advantages of surgical ease and speed as well as patient comfort. Results This study included 46 patients; 23 patients had inlay butterfly myringoplasty (group A), and 23 patients had underlay cartilage tympanoplasty. In group A, 65 % of the patients had a completely healed tympanic membrane postoperatively. Mean AB gap closure was 3.94 db. In underlay group B, 82.6% of the patients had a completely healed tympanic membrane postoperatively. Mean AB gap closure was 4.7 db. These outcomes show no statistically significant difference between both groups in terms of graft take and hearing improvement (p > 0.1). Conclusions Inlay butterfly myringoplasty is an easy, reliable, and time saving procedure that should be possible as a choice to underlay procedure. Results are comparable with underlay technique in terms of graft take rate and hearing improvement. Procedure is better regarding diminishing operative time, postoperative pain, and duration before resuming usual activities.