Article Type

Original Study


objectives:1- Evaluate the risk of ossicularchain trauma and injuries due todifferent middle ear endoscopictechniques and maneuvers. 2- Describe types, incidence andcauses of these injuries.3- Suggest methods to avoid them.Methods:Thirty temporal bones were ap-proached utilizing 0°, 30° and70°otoendoscopes with 2.7 mm and4 mm diameters. Three areas weresystematically approached in eachbone: retrotympanum, protympanumand epitympanum. They were alsomanipulated using three sets of otologicsurgical instruments: regularstraight,regular curved and especiallydesigned for endoscopic ear surgery. The most common injury was thefracture of the posterior stapedialcrus (27%). Other types were incudostapedialjoint dislocation (23%),fractureof foot plate (23%), stapesdislocation(17%), fracture both stapedialcrura (13%), fracture of the incuslong process (6%) and incudomalleolarjoint dislocation (3%).Singleinjuries were 44% and combinedor multiple injuries were 56%.Highestincidence of injuries waswiththe 70°otoendoscope(89%) andwithboth the straight and curvedregularinstruments (67%). The diameterof otoendoscopes did not affectthe number of injuries. Positioningof the scopes and familiarity withthetechnique reduced the incidenceoftrauma.Conclusions:Middle ear endoscopy can lead to a significant risk of ossicular chaininjuries with their sequelae on hearing.Minimizing this risk necessitatesadequatefamiliarity with the anatomy,techniques and otoendoscopesandusage of especially designedsurgicalinstruments. In addition,combiningboth microscopic andotoendoscopicapproaches or surgicallyassisted otoendoscopic approachescan reduce this risk considerably.

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Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.