What is endoscopic ear surgery?

The surgical techniques and approaches are constantly evolving due to recent advances in technology. The basic concept behind all these advancements is to achieve minimal access to the surgical area but at the same time achieve complete disease clearance in order to provide better surgical and patient outcomes. Endoscopes have revolutionized the field of Otology by its excellent optics, improved visualization of structures and its minimally invasive approach.

Ear diseases are one of the most common health issues faced that can affect the patient’s daily routine. Ear disorders usually present as pus discharge from the ear and reduced hearing. Ear conditions can be infection leading to ear drum perforation, destruction or fixity of hearing bones (ossicles), bone eating infection (cholesteatoma), or tumors of the ear. Ear surgeries were usually performed with the help of a microscope with a huge incision behind the ear that requires shaving of hair behind the ear. These surgeries need bone drilling most of the time. After the surgery patient are kept in the hospital for 2 days with mastoid bandage. After discharge, patients are advised to come on alternate days for atleast one week for change of dressing and are advised not to take hair wash for atleast 2 weeks. These restrictions in the daily routine rather than the surgery by itself cause a lot of social and psychological distress to the patients. Patients are not able to resume their office work or attend any social events due to head shave and a huge bandage. Here comes the role of Endoscopic Ear Surgeries.

Endoscopes at present are used only in basic surgeries like Tympanoplasty (ear drum repair), Ossiculoplasty (hearing bone repair) or in Stapedotomy (stapes surgery). (Prof) Dr Satish Nair is one among the very few surgeons in India who perform endoscopic technique in case of cholesteatoma (bone destroying infection) or tumors of the ear. The advantages of endoscopic ear surgery are it’s a day care surgery and minimally invasive that has no huge scar behind the ear. Usually there is a 2cm scar inside the hairline that is not visible. Endoscopes provide better visualization of the minute structures of the ear and hidden areas than the microscope that leads to complete disease removal and preservation of important structures. Endoscopic ear surgery does not require bone drilling and also has minimal tissue handling. There is no need for head shave or mastoid bandage after the surgery. Patients are mobilized on the same evening of the surgery and are discharged usually on the same day (within 24 hours after surgery). The post-operative pain after the Endoscopic Ear Surgery is barely noticeable. All the patients are advised to resume their daily routine after 2 days and hair wash after 3 days of surgery. Patients are advised to follow-up after one week for suture removal and on 21^st day for removal of pack (cotton wick) in the ear canal.

The paradigm is being shifted from conventional techniques to endoscopic technique due to its equitable success rate compared to conventional microscopic technique but better hearing results, cosmesis and comfort to the patient with minimal post-operative pain without any compromise to the disease clearance.

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