Learning Objectives:

Objective: The purpose of this presentation is to emphasize the importance of incorporating the endoscope together with the microscope during cholesteatoma surgery. Because poor access to the hidden recesses of the middle ear was the major reason for residual disease, therefore, angled endoscopes were considered a major adjunct in dealing with such blind spots.

Methods: Endoscope-assisted surgery (EES) helped the surgeon to overcome the limitation of the straight vision offered by the microscope. On the other hand, EES has its own peculiarities as the surgeon works practically with one hand, and in many instances uses angled-vision endoscopes. New instrumentations specifically adapted for EES are now available. Also, new technologies have stimulated the creation of powered endoscopic equipment. Both have pushed the surgeon to widen the indications of EES beyond cholesteatoma.

Results: Our results confirmed that better control over the pathology, especially in hidden recesses, is possible with the help of endoscope. Advancements in EES improved maneuverability and offered better visualization over the pathology; therefore pushing the limits of endoscope and widening its indications.

The author highlights the importance of endoscope-assisted surgery during cholesteatoma surgery and presents different recent indications of endoscope in the field of otology and skull base surgery. EES is increasingly used for removal of various middle ear tumors, middle ear exploration for CHL, otosclerosis surgery and cochlear implant surgery. Also, CPA surgery during micro-vascular decompression and acoustic neuroma complete removal from the fundus of IAC.

Conclusion: Combining the attributes of endoscope together with the microscope is the most efficacious approach and will continue widening the indications of endoscope in the future. EES is technically feasible for the majority of surgeons and should be included in all training programs and courses.