Name: Video: Exclusive Endoscopic Incus Interposition
Uploaded: 2024-01-26T14:40:00
Duration: 2 min 1 s
Description: 212 Views. Exclusive Endoscopic Incus Interposition

exclusive endoscopic incus interposition

A Comprehensive Step-By-Step Guide for Exclusive Endoscopic Ossiculoplasty

The use of endoscopes has become prevalent in modern otology. Originally used for diagnostic purposes, the endoscopic technique has gained popularity over time, leading to exclusive endoscopic ear surgery approaches. The endoscopic technique is performed through the auditory canal and requires precise and delicate maneuvers, as the technique must be performed single-handedly. It provides a panoramic view of the middle ear and allows access to hard-to-reach areas, facilitating the elimination of disease by using angled endoscopes1,2. In ossicular chain repair, modern high-definition (HD) or 4k endoscopy, along with its illuminative capabilities directed at specific structures of interest, such as the stapes or its footplate, greatly assists in the recognition of both anatomical and pathological variances3,4,5.
Ossicular chain destruction commonly results from chronic otitis media (COM), but trauma and neoplasms can alter the normal middle ear and, therefore, reduce its sound transmission capabilities6,7. Restoration of normal tympanic membrane (TM) and ossicular chain function has its roots in the 1950s8. The surgical techniques used to treat various pathologies of the middle ear aim not only to eliminate the underlying disease process but also to restore normal auditory function9.Over the past seven decades, various ossiculoplasty (OPL) techniques and prostheses have been studied and reported in the literature7,10,11.&#160;Bioinert materials like titanium gained popularity due to their lightweight, rigidity, and good visualization of their distal end during surgery. Nevertheless, these prostheses are quite expensive, and the reported rate of extrusion (1%-5%) is not negligible12. Autologous materials have demonstrated comparable effectiveness to synthetic prostheses. However, they do present certain drawbacks, such as longer surgical durations required for the remodeling process, the potential for retaining cholesteatoma, and availability limitations depending on the condition of the ossicular chain13,14.
According to Tsetsos et al., exclusive endoscopic ossiculoplasty (EEO) is associated with similar postoperative hearing results compared to the traditional microscopic approach15. A trend towards reduced morbidity and a shorter operative time for the endoscopic approach has been observed. Therefore, EEO can be considered a valid surgical option for reestablishing a functioning ossicular chain with acceptable hearing restoration in children and adults16.
This study aims to provide a comprehensive insight into the various technical refinements and latest developments for EEO. It presents different OPL techniques along with representative outcome data.

Author Spotlight: Advancing Endoscopic Ossiculoplasty &#8211; Techniques, Innovations, and Practical Guidance for Clinical Integration

Techniques of Endoscopic Ossiculoplasty

Exclusive Endoscopic Incus Interposition

Research

JoVE Journal

Medicine

212 Views. Exclusive Endoscopic Incus Interposition

Video: Exclusive Endoscopic Incus Interposition

The utilization of endoscopes in modern otology has evolved from diagnostic purposes to the development of exclusive endoscopic ear surgery. This technique offers a panoramic view of the middle ear and provides an optimal magnification of the oval window region, the stapes' suprastructure, and the footplate, allowing great precision in prosthesis positioning during ossiculoplasty (OPL). Various techniques for ossicular chain reconstruction have been described in the literature. Either autologous or synthetic materials can be used for reconstruction. The use of a patient's own tissue minimizes the risk of implant rejection or extrusion of the prosthesis through the tympanic membrane. On the other hand, synthetic materials like titanium are light and rigid and do not require time-consuming prosthesis remodeling. The main objective of this article is to present a comprehensive step-by-step guide that serves as a surgical manual for exclusive endoscopic OPL. This guide will explain various forms of OPL using synthetic and autologous materials. The goal is to provide a comprehensive understanding of the various surgical techniques and support the integration into clinical practice.

Exclusive Endoscopic ossiculoplasty (EEO) is a promising and minimally invasive approach for the treatment of conductive hearing loss due to ossicular chain disruptions and associated middle ear pathologies. Herein, step-by-step instructions and a discussion of various endoscopic ossiculoplasty techniques are presented.