Techniques of Endoscopic Ossiculoplasty

In modern otology, the use of endoscopes has evolved from diagnostics to exclusive endoscopic ear surgery. Our goal is to offer a comprehensive understanding of the various endoscopic ossiculoplasty techniques and support their integration into clinical practice. The focused illumination of specific middle ear structures such as the stapes and its footplate, allows great precision in prosthesis placement.

Furthermore, it facilitates the detection of both anatomical and pathological variances. The endoscopic technique is performed through the auditory canal, and requires precise and delicate maneuvers as it's performed single-handedly. Before implementing this technique in the operating room, we strongly advise hands-on training.

To begin, prepare all the necessary surgical tools and equipment for the procedure. After elevation of the tympanomeatal flap and establishing access to the middle ear, use a needle dissector to detach the chorda tympani from the long process of the incus. Then slightly resect the scutum with the ultrasonic device or a bone curette.

Identify the incudostapedial joint and cautiously disarticulate the lenticular process from the stapes head using a micro-hook or a small round knife. Then gently push the incus upward to detach it from the head of the malleus, and remove the incus by pulling the long process inferiorly and then laterally. To grind the graft, hold the incus using your grasping forceps and use a diamond bur to carefully drill both the long and short processes of the incus until the level of the incus body is reached.

On the opposite side of the former long process, drill an acetabulum approximately one millimeter wide to accommodate the stapes head. Next, position the remodeled incus inside the tympanic cavity. Using a micro-suction tip or a needle, precisely locate the acetabulum onto the stapes head, and if appropriate, the anterior surface in contact with the malleus handle.

Stabilize the incus interposition using resorbable gelatin sponges, and close the tympanomeatal flap. The overall graft intake rate showed a success rate of 98.3%Preoperatively, the average air-bone gap was 25.24 decibels, whereas after surgery, the average air-bone gap significantly reduced to 17.10 decibels. To begin, prepare all the necessary surgical tools and equipment for the procedure.

Disarticulate the incus from the incudostapedial joint, and then remove the incus. Identify the malleus and dissect the chorda tympani from its neck. Using the malleus nipper, transect the malleus neck and remove its head for its intended use in the Interposition Procedure.

To grind the graft, hold the malleus head using your grasping forceps, and using a bur, carefully drill until the level of the malleus neck is reached. Drill an acetabulum on the malleus head approximately one millimeter wide to accommodate the stapes head. After carrying the graft towards the tympanic cavity, position the malleus head onto the stapes head and readjust its interposition using a microneedle.

Stabilize the malleus head into position with gelatin sponges, and close the tympanomeatal flap. The overall graft intake rate showed a success rate of 98.3%Preoperatively, the average air-bone gap was 23.05 decibels, whereas after surgery, the average air-bone gap was reduced to 21.90 decibels. To begin, prepare all the necessary surgical tools and equipment for the procedure.

Assess the size of the defect and choose the appropriate size of the implant. After carrying the prosthesis towards the tympanic cavity, position the foot of the PORP precisely onto the stapes head using a microneedle. Cover the head of the prosthesis with cartilage and ensure that the implant slightly tents the tympanic membrane.

The overall graft intake rate showed a success rate of 98.3%Preoperatively, the average air-bone gap was 24.30 decibels, whereas after surgery, the average air-bone gap significantly reduced to 16.80 decibels. To begin, prepare all the necessary surgical tools and equipment for the procedure. To prepare the double cartilage block or DCB graft, obtain a rectangular block of tragal or conchal cartilage and remove the perichondrium on one side only.

Cut the cartilage in half using a scalpel, ensuring to refrain from cutting through the perichondrium on the opposing side. Create a shallow acetabulum approximately one millimeter wide to receive the stapes capitulum on the block free from perichondrium. Fold the cartilage block on the intact perichondrium.

Then position the DCB inside the tympanic cavity, and locate it precisely onto the stapes head using a micro-suction tip or needle. Ensure the stability of the reconstruction by using resorbable gelatin sponges and carefully cover the DCB with the tympanomeatal flap. The overall graft intake rate showed a success rate of 98.3%Preoperatively, the average air-bone gap was 28.90 decibels, whereas after surgery, the average air-bone gap was reduced to 24.50 decibels.

To begin, prepare all the necessary surgical tools and equipment for the procedure. Assess the integrity of the stapes footplate and prepare it for the prosthesis placement. Measure the defect between the tympanic membrane and the stapes footplate to choose the appropriate implant size.

Next, position the TORP inside the tympanic cavity and use a microneedle to locate the foot of the TORP precisely onto the stapes footplate. Stabilize the TORP by using resorbable gelatin sponges. Ensure that there is contact between the cartilage and the prosthesis once the tympanomeatal flap has been placed over it.

The overall graft intake rate showed a success rate of 98.3%Preoperatively, the average air-bone gap was 36.80 decibels, whereas after surgery, the average air-bone gap significantly reduced to 20.30 decibels. To begin, prepare all the necessary surgical tools and equipment for the procedure. Choose a platinum or polytetrafluoroethylene stapedectomy prosthesis according to the intended size of the reconstruction.

Cut the platinum wire at the base of the hook. Next, obtain a cartilage block from the tragal or conchal cartilage and create appropriate ssyTORP. Create a square block of tragal cartilage with perichondrium left on both sides.

Using an insulin needle, create a small hole in the perichondrium in the middle of the block. Insert the blunt tip of the shaft into the perichondrium hole and gently push it to penetrate the cartilage. Then position the ssyTORP inside the tympanic cavity and locate it precisely onto the stapes footplate with a micro-hook.

Establish a contact to the manubrium of the hammer if applicable. Carefully close the tympanomeatal flap with a micro-hook. The overall graft intake rate showed a success rate of 98.3%Preoperatively, the average air-bone gap was 44.44 decibels, whereas after the surgery, the average air-bone gap significantly reduced to 27.85 decibels.