Otoendoscope Assisted Ear Surgery
Periodic Research (P: ISSN No. 2231-0045
RNI No. UPBIL/2012/55438 VOL.-IV, ISSUE-I, August-2015 E: ISSN No. 2349-9435)
Abstract
Associate Professor, Deptt. of E.N.T and Head and Neck Surgery, Government Medical College & Associated Hospitals, (S.M.G.S. Hospital), Jammu,
Deepak Kotwal
Post Graduate Student, Deptt. of E.N.T and Head and Neck Surgery, Government Medical College & Associated Hospitals, (S.M.G.S. Hospital), Jammu,
Manish Sharma
Registrar, Deptt. of E.N.T and Head and Neck Surgery, Government Medical College & Associated Hospitals, (S.M.G.S. Hospital), Jammu,
Mohit Goel
Post Graduate Student, Deptt. of E.N.T and Head and Neck Surgery, Government Medical College & Associated Hospitals, (S.M.G.S. Hospital), Jammu,
Divya Gupta
Post Graduate Student, Deptt. of E.N.T and Head and Neck Surgery, Government Medical College & Associated Hospitals, (S.M.G.S. Hospital), Jammu,
Endoscopic examination of the middle ear cleft visualizes whole tympanum and the ear canal without having to manipulate the patients head or the microscope. It visualizes structure from multiple angles as compared to the microscope single axis along the canal. It provides extremely sharp image with high resolution. Other than a wider and clearer view of middle ear anatomy, endoscopy allows us to better understand middle ear physiology and ventilation pathways that might cause pathology if impaired using minimal exposure and without the time consuming removal of overlying bone. Endoscope allows the surgeon to visualize the middle ear completely and to simultaneously check the ossicular continuity and mobility.
Material and Methods
The present study was conducted in the department of ENT & Head and Neck Surgery, SMGS Hospital, GMC Jammu for a period of one year commencing from November 2013 to November 2014. The study was done on 70 patients who were admitted for surgical management of tubotympanic CSOM (safe type), atticoantral CSOM (unsafe) and secretory otitis media.
Results in Myringoplasty Group
In endoscopic group it was observed that in 95% (19patients) post operative AB Gap was less than 20db as compared to only 5%(1 patient) pre operatively and in microscopic group it was observed that in 85% (17)patients post operative AB Gap was less than 20db as compared to only 5%(1) patient pre operative AB Gap. There was significant improvement in preoperative and post operative PTA both in endoscopic and microscopic group. (p value 0.0001)
Results in Mastoidectomy Group
In 3 (37.5%) patients out of 8 patients, cholesteatoma left inadvertently after microscopic CWD mastoidectomy (Posterior to Anterior) surgery was identified and removed by otoendoscope from sinus tympani and anterior attic. Similarly in 2 (40%) patients out of 5 patients cholesteatoma left inadvertently after microscopic CWD (Inside out) surgery was removed from sinus tympani, anterior attic and protympanum. No cholesteatoma remnants left inadvertently were observed by otoendoscope in 2 patients of microscopic atticotomy. Overall incidence of cholesteatoma observed and removed from hidden areas by endoscope was 33.3% thus defining the importance of otoendoscopy in cholesteatoma surgery. Overall pre-operative AB-Gap was more than 41db recorded in 13 (86.7%) patients on PTA. Post-operative AB-Gap was reduced by 10 db in 10 (66.7%) patients.
Conclusion
Endoscopic myringoplasty was found to be equally effective and less morbid. Endoscope assisted surgery allows a better understanding of cholesteatoma and improved eradication of residual/recurrent disease from hidden areas such as facial recess, sinus tympani, anterior epitympanic space, protympanum and hypotympanum than with conventional microscopic surgery alone. Grommet insertion can be done effectively using otoendoscope.
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