Endoscopic Cartilage Tympanoplasty
The ideal purpose of the endoscope is to allow surgery through the ear canal, which is the natural opening into the middle ear (this is termed Tanscanal endoscopic ear surgery or TEES).
Microscopes have been used in otology for over seventy years. They make structures appear larger and have a very bright light. Surgical microscopes are large devices, weighing hundreds of pounds. The lens of the microscope needs to be about a foot away from the object (or target) the surgeon is looking at. As a result, other structures between the target and the lens can block the view. For example, the ear canal (or external auditory canal) is shaped like a bent tube, and can often get in the way. Bone can also obstruct the view with a microscope. To overcome blocked views, surgeons sometimes need to make a larger incision (for example behind the ear canal) or drill away bone.
The endoscope is another type of device that can help surgeons see during surgery. It is shaped like a narrow tube and the lens is at the tip. The lens can be placed extremely close to the target, less than half an inch (or thirty times closer than with the microscope). This allows a very detailed view. Because the endoscope is so narrow, it can be slid past blocking structures. In some instances, this can avoid a larger incision or prevent drilling away from blocking bone. The endoscope also provides a wide panoramic view, whereas the microscope provides a narrower view. Finally, endoscopes can have angled lenses, allowing the surgeon to literally see around corners. Endoscopes are not a new technology; however recent improvements have allowed high-quality endoscopes small enough to use for ear surgery.