Underwater endoscopic ear surgery: A systematic review.

Area of Science:

• Otolaryngology
• Minimally Invasive Surgery
• Surgical Technology

Background:

• Traditional ear surgery techniques can be limited by visualization and invasiveness.
• Endoscopic ear surgery (EES) has emerged as an alternative, offering magnified views.
• Underwater endoscopic ear surgery (UWEES) combines EES with a fluid environment to potentially enhance surgical field clarity and safety.

Purpose of the Study:

• To comprehensively evaluate the clinical indications, surgical techniques, audiological outcomes, operative efficiency, and safety of underwater endoscopic ear surgery (UWEES).

Main Methods:

• A systematic literature search was performed across major databases (PubMed, Google Scholar, Cochrane Library) up to May 2025.
• Included were original English-language studies on UWEES in human subjects (≥3 patients), excluding microscopic or animal studies.
• Data extraction and quality assessment followed PRISMA guidelines, with a qualitative synthesis due to study heterogeneity.

Main Results:

• Nine studies met inclusion criteria, detailing UWEES for canaloplasty, cholesteatoma, labyrinthine fistula repair, and SCDS plugging.
• Sensorineural hearing was preserved, with significant air-bone gap closure improvements.
• UWEES demonstrated reduced operative times, low complication rates, and >90% resolution of vestibular symptoms.

Conclusions:

• UWEES is a safe, effective, and minimally invasive surgical option for various otologic conditions.
• It provides enhanced visualization, improved hearing outcomes, and better inner ear preservation.
• Further high-quality prospective studies are recommended to validate long-term efficacy and standardize protocols.