Our Vision
Our vision is to integrate endoscopic ear surgery into the standard practice of otology in the UK. Through training, knowledge sharing, and increased awareness, we aim to move EES from a niche technique to an essential part of the modern otologist’s skillset - ultimately reaching a point where a dedicated working group is no longer needed, as endoscopic techniques become embedded within routine surgical training and practice.
History of Endoscopic Ear Surgery
Endoscopic ear surgery (EES) emerged in the 1990s as a minimally invasive alternative to traditional microscopic techniques. Initially pioneered by surgeons such as Muaaz Tarabichi, EES gained traction for its ability to provide wide-angled, high-definition views of the middle ear through a transcanal approach, reducing the need for external incisions. Over the following decades, EES gained traction in Italy and France, where early adopters integrated it into routine otological practice, leading to dedicated courses and research initiatives. In the UK, uptake was initially slow, with only a handful of surgeons exploring its applications. However, in recent years, interest has grown steadily, driven by international collaboration, improved instrumentation, and increasing evidence of its advantages. The International Working Group on Endoscopic Ear Surgery (IWGESS) was established in 2015 to disseminate best practices in research, training and performance of EES.
Advantages of the Endoscopic Approach
Advantages of Endoscopic Ear Surgery Over Microscopic Surgery
Endoscopic ear surgery (EES) offers several advantages over traditional microscopic techniques, particularly in terms of visualisation, patient outcomes, and understanding of middle ear micro-anatomy and physiology.
Enhanced Visualisation
The endoscope offers wide-angled, high-definition visualisation of the middle ear, allowing surgeons to see around corners and access hidden recesses such as the sinus tympani and facial recess without the need for extensive drilling. By limiting soft tissue disruption and preserving the bony structures of the ear, EES is associated with reduced postoperative pain, lower risk of complications, and faster recovery times compared to traditional microscopic surgery.
Potential for Local Anaesthesia Surgery
EES can be performed under local anaesthesia with sedation, particularly for tympanoplasty and select middle ear procedures, offering an alternative to general anaesthesia for suitable patients.
Expanding Applications and Innovation
The versatility of EES continues to grow, with expanding applications in cholesteatoma surgery, stapes surgery, and skull base procedures. Advances in instrumentation and surgical techniques, such as underwater drilling, further enhance its role in modern otology.
While EES does have a learning curve and certain limitations, its benefits make it an increasingly valuable tool in the modern otologist‘s armamentarium, complementing rather than replacing microscopic surgery.