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Comparison of Middle Ear Visualization With Endoscopy and Microscopy

Bennett, Marc L.; Zhang, Dongqing; Labadie, Robert F.; Noble, Jack H.

doi: 10.1097/MAO.0000000000000988

Introduction: The primary goal of chronic ear surgery is the creation of a safe, clean dry ear. For cholesteatomas, complete removal of disease is dependent on visualization. Conventional microscopy is adequate for most dissection, but various subregions of the middle ear are better visualized with endoscopy.

Objective: The purpose of the present study was to quantitatively assess the improved visualization that endoscopes afford as compared with operating microscopes.

Methods: Microscopic and endoscopic views were simulated using a three-dimensional model developed from temporal bone scans. Surface renderings of the ear canal and middle ear subsegments were defined and the percentage of visualization of each middle ear subsegment, both with and without ossicles, was then determined for the microscope as well as for 0-, 30-, and 45-degree endoscopes. Using this information, we analyzed which mode of visualization is best suited for dissection within a particular anatomical region.

Results: Using a 0-degree scope provides significantly more visualization of every subregion, except the antrum, compared with a microscope. In addition, angled scopes permit visualizing significantly more surface area of every subregion of the middle ear than straight scopes or microscopes.

Conclusions: Endoscopes offer advantages for cholesteatoma dissection in difficult-to-visualize areas including the sinus tympani and epitympanum.

*Department of Otolaryngology–Head and Neck Surgery

Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee

Address correspondence and reprint requests to Marc L. Bennett, M.D., 1215 21st Avenue South, Suite 7209 MCE South Tower, Nashville, TN 37232; E-mail:

This work was supported in part by grant R01DC008408 from the National Institute on Deafness and Other Communication Disorders. The content is solely the responsibility of the authors and does not necessarily represent the official views of this institute.

The authors disclose no relevant conflicts of interest.

Copyright © 2016 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company