A Case for Endoscopic Surgery: How Personal Experience Influenced Pursuit of a New Skill

It was 2014, and I decided to develop my skills. I registered for two courses: the Vanderbilt Endoscopic Middle Ear Surgical Dissection Course, directed by Drs. Alejandro Rivas and Marc Bennett, and the Toronto Endoscopic Ear Course, directed by the late Dr. David Pothier, and Drs. John Rutka and Ian Witterick. They were both outstanding courses. (Later, in 2016, I also attended the Harvard Endoscopic Ear Surgery Dissection Course, directed by Drs. Daniel J. Lee and Michael S. Cohen.)

About a week after the second course, I performed my first endoscopic ear case— the resection of an epitympanic cholesteatoma. The surgery went wonderfully, and I enjoyed it! The patient had a great outcome and continued without recurrence.

I started with the endoscopes and the video tower used for functional endoscopic sinus surgery, Rosen needles, straight suctions, round knives, sickle knives, etc. It worked well for tympanoplasties and epitympanic cholesteatoma. Shortly thereafter, I purchased angled endoscopic ear instruments, which allowed for deeper dissection into the posterior mesotympanum and toward the mastoid antrum.

After I found the cholesteatoma in my own left ear in 2015 and had had several debridements, I realized it would be irresponsible to delay definitive treatment further. If I were going to avoid a mastoidectomy, I would have to get to the cholesteatoma before it extended too deeply within the mastoid. I had a CT of the temporal bones. To my relief, my cholesteatoma was ideal for endoscopic resection, potentially avoiding a postauricular incision. At the time, no one in my area was performing endoscopic surgery for cholesteatoma, and, of course, I wanted the best surgeon within a reasonable distance. I had attended lectures about endoscopic middle ear surgery and using endoscopes in surgery for superior semicircular canal dehiscence by Dr. Daniel Lee at Massachusetts Eye and Ear. I knew he was a good surgeon, and I liked him. I brought him my CT, and we had a brief meeting. I wanted endoscopic ear surgery, and I knew he was the surgeon to do it.

The surgery went very well. Dr. Lee gave me a video of the procedure so I could review it post-op. My chorda tympani was sacrificed, and I had a partial prosthesis (Kurz, CliP). I required no pain medications. I had no numbness. I had no hair loss, with only a small incision to obtain conchal cartilage. My surgery was on a Monday, and I was back operating on my own patients on Wednesday. Water tasted metallic on the left side of my tongue for two months after surgery, but one day, like magic, it was gone. My hearing result was very good (only a mild conductive loss).