14/08/2010. João Flávio Nogueira Sinus Centro Fortaleza, Ceará IWGEES International Working Group on Endoscopic Ear Surgery SINUS CENTRO

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1 SINUS CENTRO João Flávio Nogueira Sinus Centro Fortaleza, Ceará IWGEES International Working Group on Endoscopic Ear Surgery 1

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3 Nogueira JF Jr, et al. A brief history of otorhinolaryngolgy: otology, laryngology and rhinology. Braz J Otorhinolaryngol. 2007;73(5): Microscope in otology Carl Nylen 1950 Nogueira JF Jr, et al. A brief history of otorhinolaryngolgy: otology, laryngology and rhinology. Braz J Otorhinolaryngol. 2007;73(5):

4 Tarabichi M. Endoscopic middle ear surgery. Ann Otol Rhinol Laryngol. 1999;108: Post-auricular incisions Easy access Direct route to middle ear Limitations of the microscope and instruments Tarabichi M. Endoscopic middle ear surgery. Ann Otol Rhinol Laryngol. 1999;108:

5 Endoscopes in otology Documentation Ambulatory exams Tarabichi M. Endoscopic middle ear surgery. Ann Otol Rhinol Laryngol. 1999;108:

6 Total visualization of the TM (no need for repositioning) Anterior vision Attic vision Hidden recesses Use of a natural access (external auditory cannal) Economics Tarabichi M. Endoscopic middle ear surgery. Ann Otol Rhinol Laryngol. 1999;108:

7 SINUS CENTRO Left ear: View of the retrotympanum. IS: incudostapedial joint; PE: Pyramidal eminence; PO: Ponticulus; ST: Sinus tympani; SU: Subiculum; RW: Round Window. 7

8 SINUS CENTRO Left ear: Overview picture of the tympanic cavity with special attention to the retrotympanum. FN: Facial nerve; SU: Subiculum; SS: Sinus subtympanicus; SE: Styloid eminence; RW: Round window; FN: Finiculus; CA: Crotid artery; HC: Hypotympanic air cell. SINUS CENTRO Left ear: HM: handle of malleus; STS: Supratubal recess; COG: the anterior surface of Sheehy s cogs which separates the attic from the supratubal recess; TFA: the vertical segment of the tensor fold which when complete, will close off the attic from the Eustachian tube; TFB: the horizontal segment of the tensor fold which forms a partial floor of the supratubal recess anteriorly; TTM: tensor tympani muscle s bony encasement; BA: Bony annulus; CA Carotid artery. 8

9 Video 14/08/2010 Endoscopes (4 mm, 0m 30 and 45-degrees) Video Instruments Instru ments 9

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11 Ventilation tubes Myringoplasty Tympanoplasty Tympanoplasty + atticotomy Cholesteatoma surgery Otosclerosis surgery Other (acoustic neuromas, etc) Tarabichi M. Endoscopic middle ear surgery. Ann Otol Rhinol Laryngol. 1999;108: Less invasive access Tarabichi M. Endoscopic management of limited attic cholesteatoma. Laryngoscope 2004;114:

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16 Female, 17 Y/O 16

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19 SINUS CENTRO SINUS CENTRO 19

20 Post-operative Pre-operative Female, 17 Y/O 20

21 Female, 33 Y/O Post-operative Pre-operative 21

22 Female, 29 Y/O Pre-operative Post-operative 22

23 Female, 44 Y/O 23

24 Female, 24 Y/O 24

25 Pre-operative Female, 32 Y/O 25

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27 SINUS CENTRO SINUS CENTRO One hand work No stereoscopic vision Adaptations Tarabichi M. Endoscopic middle ear surgery. Ann Otol Rhinol Laryngol. 1999;108:

28 Female, 49 Y/O 28

29 Initial cases Simple cases DO NOT choose revisional patients DO NOT promess your patient you won t do a retroauricular incision TALK to your patient Tarabichi M. Endoscopic middle ear surgery. Ann Otol Rhinol Laryngol. 1999;108: Need for an EXCELLENT VIDEO SYSTEM ADRENALINE soaked cottonoids in EEC ENDOSCOPES FOG BE CAREFUL with heat dissipation at the tip of the endoscope REMOVE the endoscope when doing something else Tarabichi M. Endoscopic middle ear surgery. Ann Otol Rhinol Laryngol. 1999;108:

30 Endoscopes are very interesting tools Excellent visualization Learning curve Potential for future Choclear implants, etc Indication of surgery 30

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32 "In clear contrast to the impact of the introduction of endoscope in most surgical disciplines, the practice of ear surgery has changed little and it continues to be the domain for the microscope. Depending on the task at hand, there are many distinctions that would make the endoscope a better instrument than the microscope and vice-versa. We all need to master working with both instruments to better understand and treat pathologies of the ear. The objective of the IWGEES is to neutralize these longstanding biases toward the microscope and to get all of us to use the best instrument in the best way possible to help our patients." Muaaz Tarabichi American Hospital of Dubai 32

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