Intraoperative endoscopy of the anterior epitympanum recess through the posterior tympanotomy.

INTRODUCTION: The anterior epitympanum recess (AER) is a common place of the development of the cholesteatoma, which is why removal of the matrix from this area plays a key role in the surgical treatment of chronic otitis media. AIM: To evaluate the intraoperative visibility of AER in endoscopic optics in comparison to microscopic optics and to determine the prevalence of cholesteatoma in various types of construction of the AER. Study design: retrospective analysis of intraoperative search. MATERIAL AND METHODS: The study included 55 patients treated in the Department of Otolaryngology, Medical University of Warsaw within the years 2009-2011, who underwent endoscopy-assisted canal wall up tympanoplasty with posterior tympanotomy. The type of construction of the AER - cellular or dome-shaped - was determined. RESULTS: Cellular type of recess was found intraoperatively in 32% of ears and dome-shaped in 68% of the study group. The population with chronic otitis media does not differ significantly compared to the general population in terms of the construction of the anterior epitympanum recess (p = 0.668108; χ2 = 0.1838235, df = 1). Among the ears with cholesteatoma a cellular AER was found in 48.3% of cases and a dome-shaped AER was found in 51.7%. CONCLUSIONS: The cellular type of AER was significantly more frequent in ears with cholesteatoma (p < 0.01, χ2 = 29.86492, df = 1). Level of evidence: 1b.

Comparison of visualization of the middle ear by microscope and endoscopes of 30° and 45° through posterior tympanotomy.

INTRODUCTION: Endoscopic-assisted microsurgery of the middle ear enables the field of view of the surgeon to be expanded during the removal of inflammatory tissue from the tympanic cavity and during myringo- and ossiculoplasty. Canal wall up tympanoplasty with posterior tympanotomy is a gold standard in surgical treatment of chronic otitis media. Most applications of endoscopy in middle ear surgery concern exclusively the endoscopic transcanal approach. AIM: To determine the usefulness of endoscopic visualization during the standard surgical approach through the posterior tympanotomy. MATERIAL AND METHODS: The study compared the visualization of the elements of the middle ear through the posterior tympanotomy by endoscopes with 30° and 45° optics and a microscope. Posterior tympanotomy was performed in eleven temporal bones. Visualization of the tympanic recesses was assessed on a subjective scale. A microscope and 30° and 45° endoscopes were used for inspection of the hypotympanum, sinus tympani, Eustachian tube, Prussak's space and footplate. Friedman ANOVA test and Dunn's multiple comparisons test were used for statistical analysis of the data. RESULTS: Visualization of particular recesses by endoscopes, both 30° and 45°, was excellent, while the microscopic view was statistically significantly worse, especially for sinus tympani, Prussak's space and footplate. There were no significant differences in visibility of the middle ear spaces between the two types of endoscopic optics. CONCLUSIONS: Additional application of the endoscopes during middle ear surgery provides valuable information due to excellent visualization of key recesses usually hidden from the microscope.