FCOM 2025: Endoscopic Ear Surgery

Endoscopic ear surgery (EES) has matured from a niche approach to a core technique at some centers to manage routine and complex tympanic membrane perforations, cholesteatoma, ossicular chain pathology, and select lateral skull base conditions. The following presentation will synthesize current evidence and technical refinements that improve visualization, reduce morbidity, and expand candidacy for minimally invasive transcanal, transmastoid, and transcranial procedures. The rationale for endoscopic “heads up” otologic surgery will be discussed with a review of case-based pearls for challenging anatomy (e.g., sinus tympani, anterior epitympanum), outcomes, and complication. Participants will leave with practical algorithms for patient selection, structured approaches to cholesteatoma clearance, and strategies that enhance safety and patient-reported outcomes. Device and instrument options will be discussed comparatively using only published data. By the end of this activity, participants will be able to: Differentiate indications and contraindications for endoscopic vs. microscopic ear surgery across common pathologies (perforation, cholesteatoma, ossicular chain reconstruction, lateral skull base tumors, superior canal dehiscence). Apply step-wise techniques for safe transcanal endoscopic access, hemostasis, and instrument triaging in one-handed surgery. Identify anatomic “blind spots” (e.g., sinus tympani, facial recess, anterior epitympanum) and implement visualization strategies to minimize residual disease. Compare short- and long-term outcomes (hearing results, residual/recurrence, complications) for EES relative to conventional approaches and integrate these data into procedure selection. Construct a training and adoption plan—simulation, video review, instrumentation sets, and OR workflow—that reduces the learning curve and improves team performance.