Binocular otomicroscope in the 1950s, became a revolutionary machine. Yet, it gave a global vision of all cavities of the middle ear except for the retrotympanic region. JAKO (1966) and ZINI (1967) [1] conceived the use of stainless steel micro-mirrors to investigate the sinus tympani area. This system, reflecting the light of the operating microscope, was useful in experienced hands but was not reliable for the eradication of epidermal lesions at this site.
In 1966, Harrold HOPKINS [2] developed the Hopkins rod endoscope with KARL STORZ team. KARL STORZ, manufactured in Tuttlingen, creates a cold light source, tube endoscopes and loupes. The technical quality of the lenses, lit from cold light sources, allowed very simple rapid and precise otoendoscopic examination of the tympanic membrane.
Having arrived a this stage of investigation of the eardrum, did it remain to take a decisive step? The peroperatoire use the system to visualise the middle cavities.
MER (1967) [3] employed a flexible fiberscope to examine the ears of cadavers as well as ears of living animals throught an iatrogenic myringotomy.
MARQUET (1975) [4] introduced an endoscope 1.7 mm of diameter through a tympanic perforation to observe the tympanic cavity. He already foresaw the great possibilities of the technique and wrote: “The retrotympanic regions, such as the sinus tympani, can be observed in a precise manner”.
NOMURA (1982)[5] developed a new system of rigid endoscopy used an angled rigid endoscope and called it the Needle Otoscope.
KANSAKI (1983)[6] was the first to anticipate the importance of endoscopy in postoperative surveillance of the posterior cavities of the middle ear in patients operated for cholesteatoma by a closed technique. Under local anaesthesia, he introduced an endoscope via a retro auricular incision and reported a series of 26 cases.
WULLSTEIN (1984) had a micrometric system manufactured by KARL STORZ company which call ototympanoscope. Using two endoscopes and under a visual control, this allowed the passage through the perforation of an endoscope 2.7 mm of diameter with 30° and 70° angles of vision. Nevertheless, the disadvantage of this endoscope was that both hands of the surgeon were engaged, thus preventing any treatment procedure. Ultimately, it found a little general use.
In 1984, we began using a 2.7 mm optical system with 70° angle as used for Wullstein's ototympanoscope to practice peroperating monitoring of the posterior recesses of the tympanic cavity.
In 1985, with special instruments, we performed EES of the sinus tympani area in cases of cholesteatoma surgery.
From 1988, we developped video-monitored endoscopic guided surgery for the retrotympanum and anterior epitympanum by coupling the endoscope to a micro-camera [7] [8] [9].
Endoscopic Ear Surgery in the 1990's
In 1990 [10], we carried out a second monitoring stage for cholesteatoma operated by tympanoplasty using a closed technique with a minimal cutaneous approach in the retroauricular region. In over 85%, the surgical procedure was very often combined with survey of the tympanic cavity more especially of the retrotympanum via a limited transmeatal route.
POE and BOTTRIL (1992) [11] used transtympanic endoscopy to diagnose perilymphatic fistulae and to identify other middle ear pathologies.
In 1993, MC KENNAN [12] used endoscope in second look surgery. He called this procedure: “Transcutaneous Mastoidoscopy”.
The same year, we published in Laryngoscope Endoscopic-guided Otosurgery [13] in the prevention of residual cholesteatoma. Between 1985 and 1991, 36 cases of cholesteatoma in closed technique were operated-on with a systematic control by otoendoscopy (70° angle). The residual rate was 5.5%.
Another early adopter of EES: TARABICHI, in 1997, published a series of the endoscopic management of cholesteatoma [14]. 36 cases underwent a transcanal endoscopic tympanotomy and extended atticotomy for removal of cholesteatoma.
Currently, EL GUINDY,(1992) in Egypt, investigated the utility of endoscope to perform a myringoplasty with fat graft material [15].
We started in 1993 to operate with transcanal approach for myringoplasty using abdominal fat graft with a laser fiber. The great majority of our cases were operated-on under local anaesthesia [16].
Endoscopic Ear Surgery in the 2000's
During this decade, more investigators and Otologic surgeons explored the potential benefits of endoscopic techniques in middle ear cavities and in CPA angle.
An international working group on Endoscopic Ear Surgery (IWGEES) with many surgeons was developed: BADR EL DINE, TARABICHI, PRESUTTI, MARCHIONI, AYACHE, NOGUEIRA and KAKEHATA.
From 1996 to 1998 in Marseilles, we lectured two courses on Endoscopic Ear Surgery. Today, in the world, many congresses are organized.
One of the important benefits of an endoscope compared to the microscope is the wide field of view during ear surgery. Altogether there are numerous applications in the surgery of the middle ear.
The routine, which uses optical systems for all Tympanoplasties, familiarises the surgeon with the endoscopic anatomy and provides a training for him.
