Current Status and Future Prospects of Transcanal Endoscopic Ear Surgery

Abstract

The principle behind transcanal endoscopic ear surgery (TEES) is to take full advantage of the ear canal as the most logical, direct and natural access point to the tympanic cavity and beyond. However, TEES and its potential could not be fully unlocked until the emergence of high definition (HD) imaging technology. An HD system provides a sparkling clear image with high contrast, which virtually eliminates the disadvantages of its 2D image. We have now achieved high resolution well beyond the resolution of the retina. In addition, some additional improvement can be achieved through the visual enhancement tools system which shifts the color spectrum. These advances in endoscopy have allowed a smaller endoscope to be incorporated into TEES.

The main obstacle which must be overcome in TEES is how to simultaneously use the endoscope along with other surgical instruments. While the external auditory canal (EAC) has proven to be wide enough to insert an endoscope, we also have to insert other instruments side-by-side in this narrow space. The narrowness of the EAC not only severely limits the manipulation of an instrument, it also does not permit insertion of a second instrument. While advances have been achieved in robotic surgery, again the narrow confines of the ear have prevented the use of such techniques in ear surgery. However, rather than simply wait for the miniaturization of the tools used in robotic surgery, we need to develop new surgical procedures to advance our field of ear surgery.

In this article, I will discuss how to deal with middle ear disease using TEES. Moreover, I shall show that TEES is safe and efficacious using rigid endoscopes with an outer diameter of 2.7 mm and is less invasive for patients by using the EAC as an access route to the middle ear.