Endoscopic ear surgery has progressed significantly over the past century alongside improvements in microscopy and endoscopy. While microscopy revolutionized ear surgery in the 1950s-60s by enabling binocular visualization, endoscopy offers additional advantages for procedures with narrow surgical corridors like the external auditory canal. These include a wider field of view around corners and the ability to perform surgery using only the ear canal as an access point. This preserves normal anatomy and decreases the need for bone removal. The 1990s saw early adoption of endoscopy for procedures like second look mastoidectomies. Its use expanded in the 2000s as more surgeons incorporated the techniques. Today, endoscopy provides an alternative to microscopic visualization for select otologic
Cavity obliteration is a procedure done at the end of Mastoidectomy to get a cavity-less mastoid cavity thus solving the problem of discharging post-operative cavity.
Cavity obliteration is a procedure done at the end of Mastoidectomy to get a cavity-less mastoid cavity thus solving the problem of discharging post-operative cavity.
Spaces of middle ear and their surgical importanceDr Soumya Singh
one of the imp topics in ENT that should be understood very thoroughly if u want to pursue as an otologist.I tried to simplify the topic with simple diagrams and models for better understanding .
This is a presentation I used for my seminar on 'Phonosurgery' on 4th November, 2015. I hope they are useful to you. Constructive as well as Destructive criticism welcomed.
Skull base osteomyelitis is a rare complication of otitis externa in which soft tissue pathogens have spread to the periosteum and temporal bone of the skull causing necrosis.
Spaces of middle ear and their surgical importanceDr Soumya Singh
one of the imp topics in ENT that should be understood very thoroughly if u want to pursue as an otologist.I tried to simplify the topic with simple diagrams and models for better understanding .
This is a presentation I used for my seminar on 'Phonosurgery' on 4th November, 2015. I hope they are useful to you. Constructive as well as Destructive criticism welcomed.
Skull base osteomyelitis is a rare complication of otitis externa in which soft tissue pathogens have spread to the periosteum and temporal bone of the skull causing necrosis.
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Endoscopic ear surgery offers significant advantages.
The ear is filled with tiny, delicate structures that affect hearing, balance, and facial movement. When you have a problem with the ear drum or middle ear, surgery might be needed.
We have excellent hands in endoscopic ear surgery.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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2. Introduction
Otologic surgery has progressed rapidly over
the past century
Before1920’s; loupes/without microscope
assistance
1950’s; refinement of the binocular
microscopes
Late 60’s; use of microscope to visualize
middle ear was introduced
1990’s; endoscopes incorporated in middle ear
surgery
3. Introduction to EES
Microscopic techniques, introduced in late
1950’s changed the character and outcome of
ear surgery.
Endoscope offers a same ‘game changing’
impact.
By using endoscopes, the improved access to
the tympanic cavity and proximal Eustachian
tube has allowed us to have a better
understanding of the primary disease process :
impaired ventilation.
6. History of Otomicroscopy
Otologic surgery has progressed rapidly over the past
century
Carl Olof Nylen 1921; The monocular
microscope was first applied in ear surgery.
Gunnar Holmgren 1922; developed the first
binocular microscope for use in ear surgery.
Otologists of that era in the first half of the
20th century mostly used
loupes for visualization.
7. History of Otomicroscopy
Otologic surgery has progressed rapidly over the past
century
1953, Carl Zeiss in collaboration with physicist Hans
Littman adapted and redesigned the ear microscope.
1950’s- The Zeiss OPMI-1 microscope became
widely available and revolutionized otologic surgery.
8. HISTORY OF ENDOSCOPIC EAR
SURGERY
Paralleling the introduction of endoscopes
for sinus surgery in the 1990s, otology is
facing a similar paradigm shift.
“Otoendoscopy” (The use of endoscopy to
visualize the ear) was introduced in the
late1960s.
Poor image resolution at that time, in
comparison to the operative microscope
limited its application.
9. SURGERY
Ear Endoscopy from the 1960s to the
1980s
Mer and colleagues in 1967: examined cadaver’s
ears & living animals’ ears through an iatrogenic
myringotomy.
Nomura 1982: The first myringotomy was published
- used an angled rigid endoscope and called it the
needle otoscope. Nomura’s focus was on middle
ear photography.
1989, Kimura and colleagues in Japan: used an
ultrathin fiberscope that was inserted in living
patients under LA through the eustachian tube
orifice in Nasoph.
10. SURGERY
Ear Endoscopy from the 1960s to the
1980s
Early endoscopic views of the middle ear,
1967.
(From Mer SB, Derbyshire AJ, Brushenko A, et al. Fiberoptic
endotoscopes for examining the middle ear. Arch Otolaryngol
1967;85(4):387–93)
11. HISTORY OF ENDOSCOPIC EAR
SURGERY
Endoscopy Ear Surgery in the 1990’s
The true beginnings of EES took place in the
1990’s.
Otologic surgeons started to use endoscopic approaches
not only for inspection but also to guide intervention.
McKennan in California – Second look Mastoidectomies
(Transcutaneous Mastoidoscopy) – to avoid another
postauricular incision during second-look surgery for
cholesteatoma.
Rosenberg and Silverstein – investigated this
mastoidoscopy approach further by first examining the
mastoid endoscopically via a postauricular keyhole
approach then formally opening the mastoid via the
postauricular approach.
12. One advantage of ear endoscopy over binocular
otomicroscopy is the wide field of view
13. Microscopic and endoscopic views of the right middle ear.
Daniel Lee, MD
Massachusetts Eye and Ear
Infirmary Harvard Medical
14. HISTORY OF ENDOSCOPIC EAR
SURGERY
Endoscopy Ear Surgery in the 1990’s
Muaaz Tarabichi – embraced the endoscope as
a sole mode of visualization for ear surgery, and
by the late 1990s published an important series
on the endoscopic management of
cholesteatoma.
15.
16. Tarabichi M –Endoscopic management of
Acquired Cholesteatoma. Am J Otol.
1997; 18: 5444-5449
38 adults with acquired cholesteatoma
36 underwent transcanal EES
29/30 disease free at 1 year
10/13 disease free at 2 years
4/6 disease free at 2 years (on surgical
exploration)
Transcanal Endoscopic resection of
Cholesteatoma is safe and effective.
17. The main contribution of the endoscope in my experience
has not been a technical one, but rather the different
perspective of cholesteatoma and cholesteatoma surgery
that it afforded me.
Cholesteatoma is a manifestation of advanced retraction
of the tympanic membrane, with the sac advancing into
the tympanic cavity proper and then on to its extensions
(ST,FR,HyT). Only in advanced cases, it proceeds further
to mastoid cavity proper.
The endoscope allowed a better understanding of
cholesteatoma and the way it travels through the
temporal bone
Therefore, the most logical approach to cholesteatoma is
Tarabichi M –Endoscopic management of
Acquired Cholesteatoma. Am J Otol.
1997; 18: 5444-5449.
18.
19.
20. HISTORY OF ENDOSCOPIC EAR
SURGERY
Endoscopy Ear Surgery in the 2000’s
During this decade, more investigators and
otologic surgeons explored the potential benefits
of endoscopic techniques.
Number of publications in peer-reviewed journals
dramatically increased.
Otologic surgeons tried their hands at performing
a variety of classic otologic procedures
endoscopically and reported their experiences as
well as technical tips and limitations.
Video clips of various endoscopic ear surgeries
could be found on different websites and on
YouTube.
21. HISTORY OF ENDOSCOPIC EAR
SURGERY
Endoscopy Ear Surgery in the 2000’s
The International Working Group on Endoscopic Ear
Surgery (IWGEES) formed as a consortium of otologists
interested in endoscopic ear surgery. The group promotes
endoscopic ear surgery and provides educational materials
and seminars.
26. Rational for EES
The operative microscope, pioneered in the
1950s & 1960s, is essential for otologic surgery
as it provides
1. excellent illumination,
2. depth perception and magnification,
3. binocular vision,
4. ability to work with 2 hands, and
5. capacity to capture HD images and video.
Despite these advantages, the microscope is
limited when constrained by small surgical
corridors: the External Auditory Canal.
28. Rational for EES
In cases with a small surgical corridor,
additional soft tissue incisions (endaural or
postauricular) or bone removal (canalplasty,
atticotomy, removal of ossicles, and canal up
or down mastoidectomy) are sometimes
needed to access middle ear disease.
This is especially true when
the EAC is small,
when there is a prominent anterior bony overhang
&
when the middle ear disease extends to the attic,
29. Rational for EES
The endoscope allows for excellent
visualization of the entire tympanic membrane,
middle ear because
A wide-angle lens &
Illumination emerges from the distal tip.
With the introduction of 3-CCD camera systems
and wide-format digital displays, endoscopes
now provide an immersive and high-fidelity
visual experience for the surgeon that is also
shared by observers in the operating room.
30.
31.
32.
33.
34. Main Advantages of EES
1. Using the ear canal as the natural conduit to the
tympanic cavity
2. High quality resolution and magnification
3. Restoring normal middle ear & mastoid ventilation
routes
4. Preserving as much normal anatomy as possible
by minimizing unnecessary dissection of bone and
soft tissue
5. Decreasing the need for drilling
6. Avoidance of postauricular approaches and
minimizing damage to neurovascular structures
35. Philosophy (of the experts) in
EES
David D. Pothiar
Toronto General
Hospital
36. Drawbacks of EES include;
Challenging one handed dissection without
suction in other hand
Lack of 3 dimensional view – reliance on
motion parallax to assess depth perception
Lack of exposure to these techniques during
surgical training
Limited instrumentation
37. Basic differences between
endoscopic
and microscopic ear surgery
Endoscope Microscope
Number of hands
available for dissection
One handed
(optional 2-handed)
Two handed
Typical surgical approach Transcanal (can be
postauricular for
combined cases as
well as via the antrum
following CWU
mastoidectomy
Transcanal with
speculum +- endaural
incision or postaural
Resolution High High
Binocular vision No Yes
Field of vision Wide Narrow
Ability to look around
corners
Yes (0-70degrees) No
38. Terminology of EES
OTOENDOSCOPY It involves the use of rigid (or
flexible) endoscope for inspection of the outer ear,
middle ear, mastoid, or lateral skull base.
E.E.S It involves the use of the endoscope for
simultaneous visualization and dissection of the
outer ear, middle ear, and mastoid. This applies to
transcanal, transmeatal (canal wall down cavity),
trans-mastoid, and transcranial lateral skull base
approaches.
TRANSCANAL- E.E.S (TEES) It refers to EES
techniques in which the EAC is used as the primary
surgical portal to access the TM, middle ear, and in
very specialized cases, the inner ear and lateral
40. EES Instruments
If you have FESS sinuscopes and a middle
ear instruments tray you are ready to
start…
Rigid sinus endoscopes
A light source
A HD 3-CCD Camera
A HD video monitor
Basic otological surgical instruments set
Few specialized instruments
48. Hand positioning and
placement of the endoscope
A standard otologic chair that has armrests is
essential for EES. Both forearms and elbows
should rest on the table, patient shoulder, or
armrest to maintain wrist stability and minimize
fatigue.
The endoscope may be held in a similar
fashion as during sinus surgery, with the hand
placed partly along the shaft and camera head.
The endoscope should be stabilized gently
along the cartilaginous meatus.
49. Left vs. right ear cases
For the right-handed surgeon, it is
recommended to start with left-sided EES cases
as dissection of routine and complex middle ear
disease is much easier than the right ear.
Use dominant hand for dissection in both left
and right ear cases.
50. Indications for Endoscopic Ear
Surgery
External ear
Exostosis
Canalplasty
Debridement & Bx.
EAC cholesteatoma
Middle ear
Myringotomy
Myringo/Tympanoplasty
Ossiculoplasty
Cholesteatoma
Tumors (glomus)
Stapedectomy
Inner ear/Skullbase
Intracochlear
schwannoma
Small symptomatic
neoplasm of IAC fundus
or facial N.
Petrous apex cyst
Perilymph fistula repair
Middle cranial fossa
SCC dehiscence repair
Post. Fossa/CP angle
Identification of residual
schwannoma in IAC
51. Contraindications & potential
complications
No known absolute contraindications to EES.
Any otologic case that may be performed via microscopic
techniques may be assisted by the use of an endoscope.
Potential complications of EES are identical to that of
traditional microscopic ear surgery;
Direct damage to ossicles
Direct damage to facial nerve
Heat damage to inner ear
Heat damage to facial nerve
There is no reason to believe that complications for
EES are higher than microscope-based
approaches.
Contraindications & potential
complications
52. Safety considerations specific to
EES
Potential of thermal injury from tip of
endoscope:
Power of light source no greater than 50% and
A safe distance of >5 mm from inner ear
structures
Use of 0 scopes is encouraged until comfort
is gained using highly angled scopes i.e. 30
and 45.
53. Before you begin EES
Visit the IWGEES website
www.iwgees.org
Look at the video clips
Visit the SEES website
www.sydneyendoscopyear.com
Read the SEES dissection guide, watch the
videos
Visit an IWGEES member
Attend 1 (or two) Hands-on dissection course.
54. EES courses
Harvard, USA
Vanderbilt, USA
St. Louis MI, USA
Glasgow
Toronto, Canada
Sydney, Australia
Bern, Switzerland
Cape town, SA
Fortaleza, Brazil
Modena, Italy
Nice, France
Yamagata, Japan
Dubai, UAE
Alexandria, Egypt
Jeddah, SaudiArabia
55. A 3-step process to introduce EES into
your surgical practice
1. Use the endoscope during chronic ear
surgery after the microscope-based
dissection to
a) Look for hidden disease.
b) Examine the retrotympanum, epitympanum, and
hypotympanum with a 30° endoscope.
c) Examine the antrum through the ear canal with a
30° endoscope.
d) Assess the ossicular chain and round window.
56. 2. Perform an easy transcanal procedure,
including
a) Endoscopic examination under anesthesia of EAC
and TM before microscope dissection to document
abnormality.
b) Cerumen removal.
c) Myringotomy & PE tube placement.
d) Myringoplasty.
3. Use the microscope to begin the
tympanomeatal flap; then complete elevation
with EES techniques
a) Switch to a 0° endoscope before dissection of the
A 3-step process to introduce EES into
your surgical practice
65. Promotional tips
No soft tissue injury
No head bandage/dressing
No scar
No removal of Sutures
Day-case
Minimum requirement of
analgesia
Good view, recording
Everyone is engaged
Good educational tools
66. TECHNICAL TIPS
Success in EES comes form the accumulation of many tiny tips &
pearls
1. Inject the EAC and surrounding tissues
thoroughly
2. Place cottonoids with 1:1000 adrenaline in EAC
during preparation of case
3. While you are waiting
1. Trim EAC hairs
2. Clean debris and cerumen
4. Placing the endoscope in the EAC is critical each
time
1. Use instruments to push tragus forward
2. Place in canal under screen view
67. TECHNICAL TIPS
Success in EES comes form the accumulation of many tiny tips &
pearls
5. Raising the tympanomeatal flap is often the most
difficult part: Once you reach the MEar, everything
settles down
6. Make the tympanomeatal flap more lateral than you
might expect
7. Raise the flap with a cottonoid +/- suction elevator
8. Be liberal with the cottonoids
9. Irrigate
10. 5 minutes ‘by the clock’ will solve almost everybleed
11. Take your time
68. The MEEI “10
Commandments”
of EES for the novice surgeon
1. Participate in an EES course and practice
EES in a temporal bone laboratory.
2. Essential EES surgery equipment: includes
0 and 30 endoscopes, 3-CCD HD camera,
HD monitor, and standard otologic instrument
set.
3. Discuss with OR team, anesthesiologist &
ancillary staff, the setup for EES before
beginning any case
4. The light source should be no greater than
50%.
69. The MEEI “10
Commandments”
of EES for the novice surgeon
6. Trim ear canal hair before the start of EES
cases.
7. Avoid using endoscope holders
8. Initial cases of EES; use the endoscope to
look for hidden disease after using the
microscope and then transitioning to “easy”
procedures
9. For angled endoscopes; use two hands to
introduce the endoscope into canal and
middle ear: be aware of “blind spots”.
10. Finally, keep practicing and expect setbacks.
70. Time
3 hours
3 hours
2.3 hours
2.3 hours
2 hours
Microscope Case
Endoscope Case
David D. Pothiar
Toronto General
Hospital
74. Summary
Advancing technique with many historical
precedents
Excellent tool for CSOM
Advances in anatomy of relevant structures
Expanding indications
Early days
Rapidly developing field
Requires commitment and practice
75. A truth passes through three
stages. First it is ridicule. Second
it is violently opposed. Third it is
accepted as being self evident
- Arthur Schopenhauer
76. Gunner
Holmgren
(1875-1954)
father of
fenestration
surgery.
Raymond
Carhart
(1912-1975)
first described
Carhart notch.
Julius
Lempert
(1890-1968)
developed
one-stage
fenestration
surgery.
Samuel
Rosen
(in 1953)
proposed
stapes
mobilization.
John
Shea Jr.
(1924-2015 )
father of
modern stapes
surgery.
JohnW.
House
President -
House Ear
Institute.
WearealldwarfsseatedonGiant’sshoulder.
If wecanseefarthis isnot becausewe aretall,
thisisbecauseweareseatedonGiant’sshoulder.
Iftikhar
Salahuddin
The AgaKhan
University
Hospital.