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Auricular burns associated with operating microscope use during otologic surgery
Richard F Latuska1, Matthew L Carlson, Brian A Neff
1*Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee; and †Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.
Objective:
To raise awareness of the potential hazard of auricular burns associated with operating microscope use during otologic surgery.
Study Design:
Retrospective case series and summary of the Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience (MAUDE) database of voluntary adverse event reports pertaining to microscope related auricular thermal injuries.
Patients And Setting:
All patients who sustained auricular burns while using the operating microscope during otologic surgery at 2 tertiary academic referral centers.
Main Outcome Measures:
Surgical procedure, microscope model, intensity of illumination, length of procedure, focal length, location and severity of burn, and patient outcome.
Results:
A total of 4 microscope-related auricular thermal injuries were identified from the authors' institutions. Additionally, 82 unique cases of soft tissue burns associated with the use of an operative microscope have been voluntarily reported to the FDA since 2004. A disproportionately large percent (∼ 30%) of these occurred within the field of otology, the majority of which were during tympanoplasty or tympanomastoidectomy procedures at focal length distances of 300 mm or less with xenon light source microscopes.
Conclusion:
Simultaneous advancements in light delivery technologies and lens optics have continued to improve the efficiency of the operating microscope; however, these improvements also increase the potential for thermal injuries. Although rare, a review of the FDA MAUDE database suggests that microscope-related soft tissue burns occur more frequently in otology than any other surgical specialty. A variety of factors may help explain this finding, including the unique anatomy of the external ear with thin skin and limited underlying adipose tissue. Preventative measures should be taken to decrease the risk of thermal injuries including use of the lowest comfortable light intensity, adjusting the aperture width to match the operative field, frequent wound irrigation, and covering exposed portions of the pinna with a moist surgical sponge.
Insights
Operating microscopes can cause auricular burns during ear surgery. A review of adverse event reports indicates these thermal injuries are more common in otologic procedures, necessitating preventative measures.
Area of Science:
- Otolaryngology
- Surgical Technology
- Patient Safety
Background:
- Operating microscopes have advanced illumination and optics, enhancing surgical efficiency.
- These advancements, however, may increase the risk of thermal injuries to patients.
Observation:
- A review of Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database reports identified 82 microscope-related soft tissue burns since 2004.
- Approximately 30% of these thermal injuries occurred in otologic surgery, particularly during tympanoplasty and tympanomastoidectomy.
- Burns were often associated with focal lengths of 300 mm or less and xenon light sources.
Findings:
- The external ear's anatomy, with thin skin and minimal adipose tissue, may predispose it to thermal injury.
- Otologic surgery exhibits a disproportionately high rate of microscope-related soft tissue burns compared to other surgical specialties.
Implications:
- Implementing preventative strategies is crucial to mitigate the risk of auricular burns.
- Recommendations include using minimal light intensity, adjusting aperture, frequent irrigation, and protecting the pinna with moist sponges.
