Definition and History
"Endoscopic ear surgery" or "EES" is defined as the use of the rigid endoscope, in contrast to the operating room microscope, to visualize the middle and inner ear during otologic surgery.
Similar to the early years of FESS - functional endoscopic sinus surgery, EES has been controversial since early descriptions in the 1960s. One of the benefits of an endoscope compared to the microscope is the wide-field view of the middle ear afforded by the location of the light source at the tip of the instrument and the availability of various types of angled lenses. Middle ear procedures that utilize a rigid endoscope for viewing may reduce the need to drill for enhanced exposure of the operative field. The traditional otologic operating microscopes typically require larger portals (e.g., postauricular approaches) to enable adequate passage of light for intraoperative viewing and follow-up surveillance in the clinic. One handed dissection is cited as the main drawback to EES.
The indications for this relatively new technique are evolving. The use of rigid endoscopes to perform ear surgery (operative EES), rather than just to visualize the contents of the middle ear (observational EES), is increasing as optimized instrumentation and operative approaches become available.
Classification System:
Class 0: Microscopic only case
Class 1: Inspection with endoscope
Class 2: Mixed dissection with endoscope and microscope
Class 3: Endoscopic only case