exclusive endoscopic total ossicular replacement prosthesis &#40;torp&#41;

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

In modern ontology, the use of endoscopes has evolved from diagnostics to exclusive endoscopic ear surgery. Our goal is to offer a comprehensive understanding of the various endoscopic osteoplasty techniques and support their integration into clinical practice. The focused illumination of specific middle ear structures, such as the stay piece and its foot plate allows great precision in prosthesis placement.Furthermore, it facilitates the detection of both anatomical and pathological variances. The endoscopic technique is performed through the auditory canal and requires precise and delicate maneuvers as it's performed single-handedly. Before implementing this technique in the operating room, we strongly advise hands-on training.

Exclusive Endoscopic Total Ossicular Replacement Prosthesis &#40;TORP&#41;

To begin, prepare all the necessary surgical tools and equipment for the procedure. Assess the integrity of the stapes footplate and prepare it for the prosthesis placement. Measure the defect between the tympanic membrane and the stapes footplate to choose the appropriate implant size.Next, position the TORP inside the tympanic cavity and use a microneedle to locate the foot of the TORP precisely onto the stapes footplate. Stabilize the TORP by using resorbable gelatin sponges. Ensure that there is contact between the cartilage and the prosthesis once the tympanomeatal flap has been placed over it.The overall graft intake rate showed a success rate of 98.3%Preoperatively, the average air-bone gap was 36.80 decibels, whereas after surgery, the average air-bone gap significantly reduced to 20.30 decibels.

Research

JoVE Journal

Medicine

The utilization of endoscopes in modern otology has evolved from diagnostic purposes to the development of exclusive endoscopic ear surgery. This ...

Exclusive Endoscopic Incus Interposition

Exclusive Endoscopic Malleus Head Interposition

Exclusive Endoscopic Partial Ossicular Replacement Prosthesis &#40;PORP&#41;

Exclusive Endoscopic Double Cartilage Block &#40;DCB&#41; PORP

Exclusive Endoscopic Semi-Synthetic Total Ossicular Replacement Prosthesis &#40;ssyTORP&#41;