Fischer M, Mozet C, Hesse U, Dietz A, Strauss G
Universitätsklinikum Leipzig AöR, Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Leipzig, Germany.
Laryngorhinootologie. 2012 Mar;91(3):174-81. doi: 10.1055/s-0031-1286320. Epub 2011 Oct 20.
Endoscopic inspections of the middle ear have already been described. So far, the low optical quality due to the small diameter is limiting this type of procedure. In this study the use of a miniature endoscope for visualization of the middle ear structures has been evaluated.
8 human cadaveric head specimens have been inspected. Following myringotomy, 2 miniature endoscopes were placed into the middle ear and the promontory, the incudostapedial joint, the round und oval window niche with stapes footplate were visualized and fotodocumentated. After endaural approach all middle ear structures were visualized microscopically and the quality of pictures was compared. Technical picture quality and anatomical visualization were evaluated by 5 ear surgeons. In addition, 2 interventional procedures were performed (control of ossicular chain mobility and intratympanic substance application).
Still, the technical picture quality was significantly better for the microscope. The anatomical visualization of the middle ear structures with the miniature endoscope was not inferior compared to the microscope. The feasibility of additional interventions, e.g. control of ossicular chain mobility or intratympanic substance application could be shown. An inspection of the correct prosthesis position after tympanoplasty could be evaluated, too.
This study showed that middle ear structures can be visualized by trans-tympanic miniature endoscopy equal or even better compared to conventional microscopy in spite of reduced technical quality.
中耳的内镜检查已有相关描述。到目前为止，由于直径较小导致的低光学质量限制了这类检查方法。在本研究中，对使用微型内镜观察中耳结构进行了评估。
检查了8例人类尸体头部标本。鼓膜切开术后，将2个微型内镜置入中耳，观察了岬、砧镫关节、含镫骨底板的圆窗和卵圆窗龛，并进行了拍照记录。经耳后入路后，显微镜下观察所有中耳结构，并比较图片质量。5名耳科医生对技术图片质量和解剖结构显示情况进行了评估。此外，还进行了2项介入操作（检查听骨链活动度和鼓室内给药）。
显微镜的技术图片质量仍然明显更好。微型内镜对中耳结构的解剖显示与显微镜相比并不逊色。可以证明额外干预措施的可行性，如检查听骨链活动度或鼓室内给药。也可以评估鼓室成形术后假体位置是否正确。
本研究表明，尽管技术质量有所下降，但经鼓膜微型内镜检查与传统显微镜检查相比，对中耳结构的显示效果相同甚至更好。
