Otoendoscopy: Tricks and tips for dealing with bleeding

For pediatric myringoplasty, otoendoscopy is less invasive than traditional microscopic surgery, enabling a wide-angle view and precise identification of anatomic and pathological structures. It has significant advantages, with high rates of tympanic closure, shorter operating time and simpler postoperative course. Bleeding, however, notably in children's narrow auditory canals, is a major problem, impairing visibility and complicating surgery. There are various techniques for dealing with it: cautious infiltration of the external auditory canal, and adrenaline-soaked cotton pledgets help reduce bleeding locally and absorb excess blood while keeping the tympanomeatal flap raised, increasing the workspace and protecting the flap against the instruments. Specific instruments such as suction elevators allow the surgeon to operate with a single hand while maintaining optimal visibility. Associated to controlled anesthesia with moderate hypotension and controlled hypocapnia, these techniques ensure effective management of bleeding, making the endoscopic approach more comfortable and reliable.