Tympanic Membrane Indication

The technique of otoendoscopy has multiple applications in the office-based setting.11 it also has multiple intraoperative applications. it is useful in evaluating the etiology of unexplained conductive hearing losses, examining the round window membrane prior to inserting the Silverstein MicroWick

FIGURE 17-5 The arrow points to the round window under tympanic membrane.

and steadied by placing it against the speculum. The 30-degree otoendoscope is most commonly used and provides better visualization of the round and oval widows than does the 0-degree otoendoscope. The dominant hand is left free to focus the lens and handle any instrumentation required during the procedure.

The superior optics of these rigid endoscopes makes them far more useful than similarly sized flexible endoscopes. The images provided are nearly equivalent to those of the operating microscope, whereas the angled lenses provide visual perspectives and access to the middle ear not obtainable with the microscope. A camera is attached to the otoendoscope, and the procedure is viewed on a color monitor. The physician, assisting personnel, and patient can all view the procedure on the monitor. Pictures are taken of the tympanic membrane and middle ear at appropriate moments. Four views are usually photographed on one print. Depending on the procedure being performed, these four views could include a view of the tympanost-omy site, the round window niche, the round window membrane, and the incudostapedial joint. other views may be photographed depending on the diagnosis and procedure.

The otoendoscope is then removed, and the LAT is either patched with Gelfilm covered in antibiotic ointment or allowed to heal spontaneously. Water precautions are followed until the tympanic membrane is healed.

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