Endoscopic Ear Surgery: Advancements and Adoption Challenges 

AEESSG Eyes More Widespread Endoscopic Ear Surgery Adoption

New surgical techniques often need a champion, and transcanal endoscopic ear surgery (TEES) is no exception. Fortunately, the American Endoscopic Ear Surgery Study Group (AEESSG) is doing its part by seeking new funding that it hopes will enable it to provide more training and education, attract new members, and spread the word that this minimally invasive technique deserves more widespread adoption among U.S. practitioners.

“We’re working on getting incorporated, which will really help with funding and strengthen our ability to develop free webinars, video tutorials, social media platforms, and other methods for spreading the word about TEES,” said Daniela Carvalho, MD, MMM, the group’s current president. The key message? “That TEES is amazingly beneficial not just for our patients but also for ENT physicians and the healthcare system as a whole,” given the many benefits of TEES when compared with microscope-guided techniques, she noted.

ENT physicians who become AEESSG members “will be joining a group of about 100 practitioners who share a passion for TEES,” said Dr. Carvalho, medical director of surgical services, director of the hearing and cochlear implant program, and director of the CHARGE Center at Rady Children’s Hospital–San Diego. Given the heterogeneity of the group—it includes otologists, neuro-otologists, pediatric otolaryngologists, general ENTs, and trainees—“there’s a great opportunity for some really powerful knowledge sharing.”

TEES is amazingly beneficial not just for our patients but also for ENT physicians and the healthcare system as a whole,” given the many benefits of TEES when compared with microscope-guided techniques. —Daniela Carvalho, MD, MMM

In fact, that theme of sharing is one of Dr. Carvalho’s major AEESSG goals for 2025, with members urged to develop videos that depict particularly challenging EES cases and other valuable lessons learned. “It’s always great to have colleagues, either in person or via videos, to lean on when you have a patient with a more complicated presentation,” she said.

With the group’s impending incorporation and improved funding, “we should be able to offer those videos to AEESSG members for free,” as opposed to the majority of videos and webinars offered by other groups that charge for such content. “We also plan on keeping AEESSG membership free or just charging a nominal fee.”

Dr. Carvalho is well suited to shepherding AEESSG through all of these initiatives, having served as president of the Society for Ear, Nose and Throat Advancement in Children (SENTAC), where she spearheaded, alongside “a fantastic interdisciplinary leadership team,” significant membership growth. During her stint at SENTAC, Dr. Carvalho also promoted the dissemination of several new treatment modalities for children with ENT disorders, including TEES.

She was also the first woman to join the International Working Group on Endoscopic Ear Surgery in 2010, when the technique was still in its beginning phase. With the AEESSG created in 2015, “I was thrilled, because I saw an opportunity to help practitioners in the U.S. catch up to our colleagues in Europe and other countries around the world so that we could offer this amazing technique to our own patients.”

Several factors caused the U.S. lag, such as how the U.S. Food and Drug Administration approves medical devices, “and the way a lot of our teaching hospitals favor more traditional microscope-guided middle ear surgery,” Dr. Carvalho said. “Don’t get me wrong, the microscope can be a great modality and still plays an important role” in these cases, she stressed. “But U.S. practitioners tend to be more conservative when it comes to adopting new surgeries.” As president of AEESSG, Dr. Carvalho hopes that she can help surgeons overcome some of that reticence through training, education, and advocacy. “If I can accomplish that, then I will have done my bit to advance this great technique,” she said.

Justin S. Golub, MD, MS, vice chair of faculty development in the department of otolaryngology–head and neck surgery at the Columbia University Vagelos College of Physicians and Surgeons and New York–Presbyterian/Columbia University Irving Medical Center, in New York City, is a current board member and past president of AEESSG. His advice for those interested in joining AEESSG is to visit the group’s website (endoear.org), which includes information on how to become a member, along with directions on subscribing to a mailing list that will keep you up to date on the latest advancements in TEES.

Dr. Golub also recommended attending the next AEESSG event, which is scheduled to take place during the AAO–HNSF Annual Meeting in October 2025, in Indianapolis. And he also helps run the Columbia Endoscopic Course, “where we have been teaching endoscopic ear, sinus, and skull base surgery for seven years,” he said. “We’re skipping spring 2025 for a reset, but we will be bringing it back, and it will be better than ever next Spring,” so mark your calendars for that event, Dr. Golub stressed.