Use of miniature endoscopes and other instruments allows for minimally invasive ear surgery with less need for external incisions or drilling.
A relatively new addition to the art of middle ear surgery is the use of very fine endoscopes. The advantage of an endoscope is that the light and recording source for the image are at the tip of the endoscope so they produce close up images not bound by the line of site. Endoscopes are available in straight (0 degree) or angled (30, 45, 70 degree) and allow visualization around corners. For this reason select middle ear operations are enhanced by the use of the endoscopes which allow for less removal of bone and tissue. The angled endoscopes do not require straight line of site.
There are however a few disadvantages in use of the endoscopes. The surgeon needs to be very facile in use of the endoscopes since the surgery is quite challenging. The entire middle ear cavity is about one cubic centimeter and houses very fragile and important structures. Unlike endoscopic sinus surgery where the shaft of the endoscope could rest on nearby structures during surgery, in middle ear surgery the scope cannot touch any of the middle ear structures. The other disadvantage is that one hand of the surgeon is occupied holding the endoscope so two-hand surgery becomes impossible.
Despite its challenges and limitations, endoscopic middle ear surgery allows for better visualization and potentially less invasive surgery. Theoretically better visualization should also lead to better outcome but this has never been systematically studied. Dr. Monfared uses endoscopes for select cases such as cholesteatoma surgery were slight residual disease could lead to recurrence.