Endoscopic Ear Surgery

In this episode, Dr. Alejandro Rivas and Dr. Brandon Isaacson join Dr. Gopi Shah and Dr. Ashley Agan to discuss endoscopic ear surgery.

Dr. Rivas and Dr. Isaacson describe the evolution of endoscopic ear surgery and its adoption in the United States. They emphasize the utility of the endoscopic approach for visualization of the middle ear.

They then delve into indications and anatomic considerations when selecting the endoscopic approach. Dr. Isaacson states that for most diseases limited to the middle ear, he uses the endoscopic approach. For extensive mastoid disease, aggressive cholesteatomas, or skull base disorders, he prefers the microscope. Dr. Rivas touches upon his guidelines for selecting his approach for cholesteatomas and notes that the presence of ossicular or lateral canal erosion or an ossified mastoid typically preclude his use of the endoscope. He then highlights the benefit of the endoscopic approach in congenital, pediatric, and revision procedures. The advantages of both the endoscopic and microscopic approaches are also considered.

The discussion then focuses on optimal pre-operative and anesthesia set up to limit bleeding in endoscopic ear surgery. Lastly, the role of using endoscopes for a thorough ear exam is emphasized.