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Transcanal Endoscopic Ear Surgery for the Management of Congenital Ossicular Fixation
Vivian F Zhu1, Yann-Fuu Kou, Kenneth H Lee
1Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Insights
Transcanal endoscopic management effectively improved hearing in pediatric patients with congenital ossicular fixation. This minimally invasive technique avoids incisions and preserves hearing structures.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Congenital ossicular fixation presents challenges in pediatric audiology.
- Traditional surgical approaches may involve postauricular incisions.
Purpose of the Study:
- To describe the transcanal endoscopic technique for congenital ossicular chain fixation.
- To evaluate the outcomes of this endoscopic approach in pediatric patients.
Main Methods:
- Retrospective review of eight pediatric patients (ages 6-12) undergoing transcanal endoscopic management.
- Procedures included ossicular chain mobilization, ossiculoplasty, or incus interposition.
- Audiological outcomes and intraoperative findings were compared to preoperative data.
Main Results:
- Six of eight procedures demonstrated improvement in pure-tone average and air-bone gap.
- No complications or reduction in bone conduction hearing occurred.
- Chorda tympani nerve was preserved in all cases, with no need for conversion to open approach.
Conclusions:
- Transcanal endoscopic management is a successful technique for pediatric congenital ossicular fixation.
- The endoscopic approach offers excellent visualization and avoids postauricular incisions, improving patient outcomes.
Objectives:
1) To describe the technique for transcanal endoscopic management of congenital ossicular chain fixation. 2) To highlight the utility and outcomes of the endoscopic approach for management of congenital ossicular fixation.
Study Design:
Retrospective patient series.
Setting:
Academic tertiary pediatric hospital.
Patients:
Pediatric patients (age 6-12) undergoing transcanal endoscopic management of congenital ossicular fixation from May 2014 to December 2014.
Interventions:
A transcanal endoscopic approach was used in eight procedures. Ossicular chain pathology was managed with either mobilization, ossiculoplasty with a stapes prosthesis, or incus interposition.
Main Outcome Measures:
Pure-tone averages, speech reception thresholds, and speech discrimination scores were recorded pre- and postoperatively for each subject. Preoperative computed tomography evaluations were compared to intraoperative findings for each subject.
Results:
An improvement in the pure-tone average, as well as air-bone gap, was noted after six of eight procedures. No patients experienced a complication or a reduction in their bone conduction hearing. The chorda tympani nerve was preserved in all eight patients. Conversion to open approach was not necessary for any of the eight procedures performed.
Conclusion:
The transcanal endoscopic approach was successful in improving hearing in pediatric patients with congenital ossicular fixation that involves any of the three ossicles. An endoscopic transcanal approach provides an alternative method to manage congenital ossicular pathology with the advantage of providing excellent visualization and the avoidance of a postauricular incision.
