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~ ~ ~ ~ ~ ~ ~ ~ ~ J ~ : : " " J K SCIENCEIREVIEW ARTICLE I
Oto-Endoscopy - An Advancement in OtologyDes Raj Bhagat, Padam
Singh, Vijay Gupta
endoscopic image on the film. TI,e photography of thetympanic
membrane is at 2 cm approximately (2).Otoendoscopy is being used
for various proceduresby otologists and has an upper edge of being
very
useful technology in the modern days. It hasre\olutionized the
field by helping in diagnosis as wellas treatment of various
conditions of the ear. Thisknowledge goes a long way in planning
the surgicaltreatment to be employed in tackling a part
icularcondition. I l can be performed in the ou tpati entdepartment
with little inconvenience to the patientand with minimal risk.
Exploration of the middleear can now bc accomplished using modern
technology fibreopticlrigid telescopes. Endoscopes withsmall
diameters and with wide fields of viewprovidc extraordinary
visualization of the middle earwhich was previously accessible only
by the surgicalmeans (I).
Usually the otoview endoscopes in the size of 1.7nun with 0 - 30
view of angle and in size of 2.4111m with O. 30 and 70 degree view
of angle are used.
The use of endoscopes for the middle ear was firstdescr ibed by
Mer el. at. (3) who used fibreopticsystem delivered through the
existing tympanicmembrane perforations in two paticnts. Eichner
(4)popularized rigid e!,doscopes for improved resolution.Endoscopy
of the middle ear has been previously usedas an adjunct to
microscopic examination in the office(5). Alunad (6) has described
thc successful use of30 fibreoptic Hopkin's rod telescopc for the
postoperative follow-up of the mastoid cavity withgratifying
results.
Using a O-degree endoscope, the intact drum callbe examined and
the movements of thc ear drumevaluated. A fluid level due to middle
ear effusiollcan also be seen much more clearly with
otoendoscopethan with conventional otoscope. A 30-degreeendoscope
can somet imes be passed through the
Endoscopic photography came with the advent of perforated ear
drwn to detern1ine the integrity of thethe Hopkin's optical system.
a wide angle endoscope tiny bones ill the middle ear and also to
diagnose theafforded an enlarged field of vision. An endoscopic
disease in hidden areas of the middle ear (7). The rigidphotograph
will make it much easier for the patients endoscopes have also been
used for endoscopicto understand a simple explanation for their ear
transcanal myringoplasty. The endoscope is passedproblems. In
surgery, photos provide clinical through the perforated ear drum to
visualize the statusinfonnation about lesions and may help the
surgcon of ossicles, eustachian tube ori fice and the status ofto
decide on the surgical approach and technique. A middle ear mucosa.
Also the presence of middle earwide angle lens gives a great depth
of field. A lens cholesteatoma and granulations can be \'isualized
(8).set at infinity provides a sharp image, starting at 2.5 The
graft take-up rate of myringoplasty usingmm. This is excellent for
photography of a mastoid endoscopy is 91.7% and the closing of air
bone gapea\it)'. Thc focal length used is 140 tUm and the choice to
less than 10 dB in 83.3% cases has bcen seen (9).of the focal
length determines the size of the Otoendoscopy. also gives bet ter
visualization of---------------fromlhe Departlllent of E N 1 ~ SMGS
Hospital, Government Medic:.d College, Jammu (J&K)
India.Correspondence to : Dr. Des Raj Bhagat C/o Dr. Padmn Singh,
Lecturer. Deptt. of ENT, SMGS Hospital (GMC) Jammu (1&K)
India.Vol. 5No.3. july-September 2003 98
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J K ; . . : . , S _ C _ I E _ ~ , ; " C _ E. . . . . . ;- - - -
- - - - - - - ~ -retraction pockets as compared to
cOI1\cntionalOlOSCOP) (10). Indirect examination \\ ith a mirror
ordirect examination with the 90 needle te le scope(middle ea r
endoscope) may visua li ze the hiddenborders of the retraction
pockets (11).
The use of rigid endoscope provides a large field ofview which
is of excellent revolution a,ld fidility ofcolour as well as gi \'
ing good size views (7). Hopkin'srod rigid endoscopes of less than
3 111111 diameter ma)bc passcd into the middle ear cleft via the
drum ormastoid for diagnosing \\hethcr the cholesteatoma
hasrecuITed behind the drum head or posterior canal wall.One
millimetre Oexible endoscopes are available \"hichcan be passed
through the eustacltian lUbe for the samepurpose (12). O t o e n d
o s e o p ~ (mastoid telescope) isprefelTcd instead of re-opening
the post-aural wound atthe second stage of a combined approach
tympanoplas!).Film) adhesions in older children and bon)
overgrO\\1hin young ones. make a poor view in the majority ofthe
Cases m,d furthermore this techniquc is less practicalthan it secms
( \3). Otoendoscopy also enables viewingof different angles of
tympanomastoid area and approachto them for beller prognosis. A
compara tive study ofpost-operative mastoid cavities lIsing
Hopkin's telescope,otoscope and microscope has shown bener results
withtelescopic endoscope. Visualization of the sinoduralangle and
tip cells. sinus t) mpani. facial recess andossicles is far
superior by rod telcscopes. The degTeeof epithelization and
condition of the graft margins canbe accurately assessed b) the
telescope. The sinoduralangle and the tip cel ls arc evaluated with
70 telescope.sinus tympani. racial recess and eustachian tube
arevisuali7.ed with 30 telescope. Rest all s tructures canbe seen
with an end on telescope (I).
Rigid otoendoseopy is also useful intra-operativelyin detecting
completely removed cholesteatomas. andto learn whether "second
look" procedures are stillneeded in chi ldren. For this purpose.
30, 2.7 111mendoscope is used to evaluate the middle ears. Whenused
imra-operalivcl). if the residual cholesteatoma isseen. the removal
continues until all visualized withthe endoscope is removed and if
the cholesteatoma is99
not ren10ved intact. a planned e x p l o r a t o r ~ surgl.:r:
i.performed (1
