Oto Endoscopy

Embed Size (px)

Citation preview

  • 7/29/2019 Oto Endoscopy


    ~ ~ ~ ~ ~ ~ ~ ~ ~ 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

  • 7/29/2019 Oto Endoscopy


    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

  • 7/29/2019 Oto Endoscopy



    can also evaluate ccrlaill types or hearing loss.look through a chronic perforation to determine

    to the hearing bones and ear drum, or whetherembranes (weI' the round window Ileed to bebefore medication into the middle ear and

    car.In general. variolls procedures performed under

    control include (I)RcmnV