Endoscopic surgery is a means in which we do surgery in the ears using a device such
as an endoscope like this, which enables us to see through narrow canals,
and also have a better view of the middle ear spaces.
Now, it was initially used as a diagnostic tool
but given that the view is much better than other parameters that we have such as a microscope,
increasingly a lot of surgeons are beginning to turn towards it, using it for surgery -
resulting in much better results, when applicable.
There are a lot of surgeons that use it for all range and all manner of ear surgery;
which includes chronic ear disease as in cholesteatoma
where you have disease growing into the middle ear spaces,
but you can also use it to repair holes in the drum,
repair abnormalities within the ear canal itself
and some people try using it for skull-based surgery just because of the superior view that it gives
and also enables one to do things that we otherwise would have had to make very large
incisions or cuts in the ear and in the head in order to achieve.
All ear surgical conditions beyond the ear canal can be treated with ES. In fact, conditions
within the ear canal can be treated with ES. By using the endoscope you're able to have
a very good view of the lesion within the ear canal such as some bony lesions in the
ear canal or soft tissue masses within the ear canal.
Holes within the drum or perforated eardrums can be repaired very well with an endoscope,
because you're able to have a good look at it and achieve very good closure with them.
You can reconstruct the hearing with the endoscope.
People use it for stapedectomies or middle bone reconstruction in order to improve people's hearing.
In conditions like cholesteatoma, there are increasingly people using it for removing the cholesteatoma in the ear
with the effect of avoiding a very large cut which in itself can carry some problems
and also removing less normal tissue than you otherwise would have to
if you are doing it by a traditional approach.
Cosmetically it's much better because you're not dealing with a big scar
and also in my hands I found that the hearing results with using the endoscope
is far better than when I used to use a microscope.
The main advantage is visualisation.
The slight disadvantage from a surgical point of view is that you're restricted to one hand
and you do not have as much depth perception.
But with experience the view seldom affects the depth perception problem that you have
with the endoscope and also you get proper sort of stimulus from the opposite hand while
holding the endoscope.
So really with experience it's a very slight disability as it were.
In terms of being unable to use two hands to do the operation,
well, nowadays some surgeons are using endoscope holders,
but most surgeons are able to get by doing a surgical procedure with one hand.
The difference between the endoscope and the microscope is that with the microscope it's a much
larger device which entails you using binocular vision to see objects
which gives you advantage of both modification and depth perception.
The endoscope is a much smaller device which you virtually visualize on a screen.
The degree of view that you have with these screens are much better
and gives you a better view of the structures in order for you to do surgery.
So, it's less bulky but more versatile in terms of how you can use it and also
how soon and how effectively deal with the pathology in hand.
With endoscopic ear surgery there's very little scarring because the scar that's required
for using a microscope is much bigger and the scar itself can cause problems with keloid
formation or pain or numbness on the ear, whereas with the endoscope you bypass all that
because you're actually operating closer to the pathology at hand.
Hence, less tissue exposure or tissue damage is required.
It's also a faster operation to do for similar conditions.
In my hands, the hearing results are much better with the endoscope.
So is the perforation rate closure with the endoscope
because it's more precise in replacement of your graft when you're doing the ear surgery.
Apart from it being faster to do, the healing time is actually faster
and from the patient point of view the cosmesis is far superior when you do the operation endoscopcally,
because the scar is virtually invisible
as against a big scar outside the ear which sometimes can affect hair growth.
So especially in men that are bald, they may not necessarily want the scar to be that visible.
All patients require ear surgery can be used or can be done with the endoscopic surgery.
The only proviso is if the disease is extensive.
In the technical term, is it very extensive if it's going right up to the mastoid tip,
then you want to open up the whole area because you need a large exposure anyway
and these tissues are already damaged,
but if you have limited disease within the mastoid itself or within the ear itself or within the ear canal,
all these patients can be very effectively treated endoscopically.
This would also extend to children with glue ears.
You can use an endoscope rather than a microscope to do the operation
and with good effect.