Transcanal endoscopic stapedotomy

Stapedotomy can be technically difficult and challenging due to anatomic variations in size, configuration, shape, or irregularity of the external ear canal. The stapes and oval window niche (OWN) can be obscured by the scutum. Transcanal endoscopic approach can improve the visualization of the middle ear structures and obviate the need to manipulate the chorda tympani nerve in order to obtain adequate access to the stapes and OWN. The transcanal endoscopic stapedotomy (TES) can be utilized in patients with unfavorable external or middle ear anatomy, in candidates for revision or bilateral stapedotomy, in patients with already impaired taste sensation, with food-, smell-, or taste-related occupations, and in those for whom the taste of food contributes appreciably to their quality of life. Surgical Technique. TES is performed using rigid endoscopes 3-mm diameter, 14-cm length, 0° and 30°. The external ear canal is injected with lidocaine 1 % with 1:100,000 epinephrine. A posterior tympanomeatal flap is elevated transmeatally and transposed anteriorly. The stapes tendon cutting is performed with curved microscissors, and the stapes is separated from the incus in the incudostapedial joint. The anterior and posterior stapedial crura are carefully fractured, and the superstructure is removed. The hole in the footplate is created with a Skeeter microdrill using a 0.5-mm diameter diamond burr or gentle perforator. A platinum/fluoroplastic piston prosthesis (0.4-mm diameter, 4.5/4.75-mm length) is placed into this hole and fitted along the long process of the incus. The tympanomeatal flap is repositioned, and the external auditory canal is filled with Gelfoam®.