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Otoendoscopy
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
David A. Bowdler, Annabelle C.K. Leong, David D. Pothier
From the early 1980s onwards, otoendoscopy was increasingly used to inspect and diagnose middle ear disease, particularly residual disease after canal wall up mastoidectomy procedures.7–11 Second-look operations in patients who had previously undergone intact canal wall mastoidectomy with tympanoplasty operations were performed with the aid of otoendoscopes to exclude residual epitympanic or mastoid cholesteatoma.9–11 Thomassin strongly influenced the field of endoscopic middle ear surgery by emphasizing the use of endoscopes to search for and remove disease in the anterior epitympanic recess, tubal orifice and sinus tympani with special microinstruments and observed a distinct reduction of residual cholesteatomas as a result. He also advocated the otovideoendoscopic technique, which involved coupling of the endoscope to a camera and performing the operation while looking at the video image.12
Anatomy
Published in Stanley A. Gelfand, Hearing, 2017
The mastoid portion lies behind and below the squamous, and forms the posterior aspect of the temporal bone. The mastoid portion attaches to the parietal bone superiorly and to the occipital bone posteriorly. It projects downward to form the mastoid process, which appears as a somewhat cone-shaped extension below the base of the skull. The mastoid process contains interconnecting air cells of variable size, shape, and number. Continuous with these air cells is a cavity known as the tympanic antrum, which lies anterosuperior to the mastoid process. The antrum also connects with the epitympanic recess (attic) of the middle ear via the aditus ad antrum. The antrum is bordered inferiorly by the mastoid process, superiorly by the thin bony plate called the tegmen tympani, medially by the wall of the lateral semicircular canal, and laterally by the squamous part.
Test Paper 5
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
A 29-year-old man with history of discharge from the right ear underwent a CT of the temporal bones for further evaluation. Coronal CT images showed enlargement of the epitympanic recess and erosion of the walls and scutum with an associated soft-tissue mass. Only fragments of the ossicular chain could be identified. What is the diagnosis? Cholesterol granulomaAcquired attic cholesteatomaCongenital cholesteatomaCarcinoma of the middle earMalignant otitis externa
Improvement of otoendoscopic surgery for epitympanic cholesteatoma invading the mastoid
Published in Acta Oto-Laryngologica, 2019
Nan Wu, Fangyuan Wang, Zhaohui Hou, Shiming Yang
Surgery always starts from the acoustic meatus approach. An incision is made on the acoustic meatus under an otoendoscope to lift the skin flap. The margin is 2 cm away from the tympanic anulus (Figure 1(a)). The tympanic membrane is lifted and separated from the manubrium of malleus. The flap is turned downward to the hypotympanum cavity and fixed, so that the cholesteatoma in the mesotympanum and posterior tympanum can be eliminated under the otoendoscope. If a retraction pocket is formed in Prussak’s space and is located outside the incudomalleolar joint and the backward extension range of cholesteatoma is limited within the tympanic antrum, the mastoid does not need to be opened. Scutum bones should be removed to expose edges of the epitympanum above the incudomalleolar joint. Cholesteatoma at the external side of the ossicular chain is eliminated downward along the edges under an angular otoendoscope (Figure 1(b)).If the epitympanic cholesteatoma is located in the inner side of the ossicular chain and extends into the mastoid, scutum bones should only be partly removed under an otoendoscope through the acoustic meatus. Then, the incus and head of malleus are taken out. A limited incision behind the ear is made, and the lesion in the mastoid is eliminated under an otoendoscope or microscope. Scutum bones close to the zygoma are drilled. Thus, the anterior epitympanic recess (AER) can be exposed from the direction of the mastoid as much as possible (Figure 1(c)). Given the removal of the head of malleus and incus, a space is available for the insertion of the 45° otoendoscope into the epitympanum from the mastoid. Under the direct view of the otoendoscope, cholesteatoma in the epitympanum can be eliminated completely from the back forward (Figure 1(d)).If surgeons cannot accurately judge whether the cholesteatoma invades the mastoid by routine CT of temporal bone before operation, a key hole will be made on the back wall of the acoustic meatus. The bone at approximately 1.5–2 cm above the short process of malleus is drilled to expose the tympanic antrum inside. The key hole directly faces the lateral semicircular canal. After making a 6-mm key hole, a 45°otoendoscope with 3 mm-diameter can be inserted to observe the epitympanum, tympanic antrum, and mastoid. Surgeons can judge the invasion scope of cholesteatoma in the early stage of operation (Figure 1(e)).Although the improvements aim to reduce or avoid drilling on the scutum, cholesteatoma usually erodes the scutum before surgery. The repair using full-thickness cartilage is needed at the end of the operation.