Surgical Videos

A young boy received a slap trauma to the ear. He developed a profound sensori-neural hearing loss in that ear, and some mild vertigo. He presented after several weeks. Indications: to explore ear and check for persistent perilymph leak due to possible stapes dislocation or window leak, because this would leave him at risk of meningitis with any URTI. Procedure: tympanotomy, identification of RW leak and place tissue seal

Small Glomus Tympanicum tumour visible through tympanic membrane as a pulsatile red flush, removed by canal-pasty and tympano-meatal flap, with bipolar cautery plus KTP laser.

Chronically infected ear with poor response to medical and surgical care, no residual hearing. Mucosal disease cleared from middle ear, mastoid and ear canal. Eustachian tube, middle ear, mastoid cavity and ear canal obliterated and sealed in layers, and ear external meatus closed.

On a rural ear camp in remote western Nepal, a patient has a very large chronic aural polyp coming out of ear meatus. This arises from a large perforation of the ear drum. The middle ear is full of bleeding granulation tissue, but the ossicular chain is intact. The polyp and inflamed tissues are cleared and the drum reconstruction.

Elderly man presented with CSF leak into the middle ear and mastoid, through a large tegmen tympani defect. His hearing was good for age. The leak was approached via an extended cortical mastoidectomy and repaired in layers with bone, cartilage, and soft tissue grafts. Hearing and ossicular function was maintained.

Endolymphatic sac, or saccus surgery for Ménière's disease has been a controversial topic. However some patients do appear to get sustained symptom relief, though the mechanism and pathology behind this is much debated. Whether to merely decompress the bone overlying the sac, or incise and drain the sac is debatable, and some now advocate identifying the endolymphatic duct and clipping this. The approach varies with changing theories of the normal and the disordered function of the saccus. This video demonstrates an approach to the sac and its duct. This surgical option may be suitable when medical measures such as conservative management or intra-tympanic injections of steroid have failed to give adequate relief and when there is still useful residual hearing in that ear. Usually existing hearing is retained with this procedure.