scopic ear surgery (EES) is emerging as the future of inner ear inter-
ventions because surgeons who operate through the ear canal with an
endoscope can see around bony corners. That's a tremendous benefit
when diagnosing and treating chronic ear infection conditions or find-
ing and removing cysts that grow behind the eardrum, says Elliot
Kozin, MD, an otolaryngologist at Massachusetts Eye and Ear in
Worcester, Mass.
While visualizing and excising cysts with a surgical microscope
often requires removing large amounts of bone through an incision
made behind the ear, the endoscope lets surgeons see into the
recesses of the inner ear where they could previously not see with
a microscope, says Dr. Kozin, letting surgeons remove some
growths directly through the ear canal with minimal bone removal.
Traditional instrumentation has been designed for line-of-sight sur-
gery with microscopes, so new tools are being developed that fit
alongside the endoscope in the ear canal.
"We're going to see greater advances in EES as these ancillary
instruments come online," says otolaryngologist Aaron
Remenschneider, MD, MPH, a colleague of Dr. Kozin's at
Massachusetts Eye and Ear.
Ultra-high-definition imaging has also helped surgeons overcome
some of the visualization limitations associated with EES. "Past cam-
eras didn't have the quality to provide clear, crisp images of anatomy,
which are essential to guide dissection," says Dr. Kozin. "Now, with
high-definition cameras and relatively small and angled endoscopes,
we can see clearly throughout the middle ear space."
The heightened interest in EES should lead to more doctors adopt-
ing the technique in the coming years, says Dr. Remenschneider. "A
new generation of otolaryngologists that has trained with the endo-
scope will expect facilities to have the devices available," he says.
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