Endoscopic Ear Surgery

Endoscopic ear surgery is a new technique being pioneered at Columbia Otolaryngology. In fact, the endoscopic ear surgery program at Columbia was the first in the New York metro area. In some cases, endoscopic ear surgery may result in a less invasive operation that can be performed entirely through the ear canal.

The ear contains some of the smallest structures that can be operated on. For example, the three bones of the middle ear (called ossicles) are the smallest bones in the human body. The smallest of these (the stapes) is so tiny that seven of them could fit across a penny. In order to perform surgery on anatomy this delicate, surgeons often use a microscope.

Microscopes have been used in otology for over seventy years. Surgical microscopes are large devices, weighing hundreds of pounds. The lens of the microscope needs to be about a foot away from the object (or target) the surgeon is looking at. As a result, other structures between the target and the lens can block the view. For example, the ear canal is shaped like a bent tube and can often get in the way. Bone can also obstruct the view with a microscope. To overcome blocked views, surgeons sometimes need to make a larger incision or drill away bone.

Microscope versus endoscope during middle ear surgery. The yellow beam is the path of light.

An endoscope is another type of device that can help surgeons see during surgery. It is a narrow tube with a lens at the tip. The lens can be placed extremely close to the target, less than half an inch (or thirty times closer than with the microscope). This allows a very detailed view. Because the endoscope is so narrow, it can be slid past blocking structures. In some instances, this can avoid a larger incision or drilling a bone. The endoscope also provides a wide panoramic view, whereas the microscope provides a narrower view. Finally, endoscopes can have angled lenses, allowing the surgeon to see around corners. Endoscopes are not a new technology; however recent improvements have resulted in high quality endoscopes small enough for ear surgery. 

The microscope and endoscope each have their own advantages and disadvantages. The microscope produces three dimensional images, whereas the endoscope produces two dimensional images. However, because the endoscope can be easily moved around, surgeons can get a sense of 3D. The endoscope must also be held in the surgeon’s hand, leaving only one hand left to operate. As a result, endoscopic ear surgeons need specialized experience.

The endoscope may sometimes be used in combination with the microscope. For example, after removing a middle ear growth called a cholesteatoma, a surgeon may use an endoscope to look around to see if any pieces are left.

The ideal purpose of the endoscope is to allow surgery through the ear canal, which is the natural opening into the middle ear.

Surgeons at Columbia University Irving Medical Center are actively researching what types of surgeries are best for an endoscopic approach, such as eardrum perforations, cholesteatomas limited to the middle ear, and problems with the ossicles (bones in the middle ear).