Mary Ashmead, MD, uses an endoscope every day as a general otolaryngologist in north Texas, but almost exclusively for sinus cases. When she heard about a course on endoscopic ear surgery (EES) being offered at nearby University of Texas Southwestern, she decided it was time to learn some new skills and put her experience to wider use.
Explore This IssueMay 2020
Over two days, she learned about endoscopic tympanoplasty, endoscopic ear surgery in children, endoscopic procedures for cholesteatoma, and many other EES procedures. She said it was well worth the time: She’s now performing procedures using EES that she might have previously performed with a microscope or referred to someone else.
“I feel very confident with use of endoscopes—more so than the microscope—and wanted to be able to use those skills in a different way,” she said. “While I’m not going to do something out of my scope of practice, it gives me new tools to use within my current scope of practice.”
Dr. Ashmead has performed several endoscopic ear procedures, mostly tympanoplasties and debridements, and a simple cholesteatoma case was on the schedule at the time of the interview. “Patients in general are very accepting of less invasive procedures,” she said. “I’ve had patients who would have needed a retroauricular approach to their perforation using a microscope who did not want surgery. But when they found that endoscopic tympanoplasty was an option, they were much more amenable to proceeding.”
Dr. Ashmead is part of a movement toward increased use of the endoscope for performing ear surgeries that have traditionally been performed using microscopes. With an endoscope, surgeons have wider visualization of the surgical area, are able to see around anatomical corners, and can perform procedures through the ear canal without having to create an incision behind the ear—making it an attractive option for patients.
One drawback is that EES is a one-handed surgery; the other hand has to hold the scope. Another hurdle is that suctioning away blood is more difficult, and even experienced endoscopic ear surgeons say they shy away from cases with excessive inflammation because of the potential for a lot of bleeding.
Still, interest in EES continues to grow. A 2019 paper—one of the most recent attempts to quantify interest in EES out of the United Arab Emirates—found that there were 57 articles published on the use of the endoscope in ear surgery between 2001 and 2010, rising to 351 between 2011 and 2018. From 2001 to 2010, 20 of the publications were on the diagnostic use of the endoscope related to ear surgery, and 27 were on endoscopic ear surgery specifically. That has changed: Of the 351 papers published from 2011 to 2018, 283 were on endoscopic ear surgery, and just 44 were on use of the endoscope for diagnostic purposes. The other few were on endoscope-assisted ear surgery (Laryngoscope Investig Otolaryngol. 2019;4:365-373).