New Developments in Otology From Japan: TEES and Beyond (2023 AMW)
2023 AAO-HNSF Annual Meeting & OTO Experience
PROGRAM DESCRIPTION: We introduce advances on transcanal endoscopic ear surgery (TEES) developed in Japan Otological Society.Transcanal Endoscopic Ear Surgery (TEES) has further developed and expanded in the intervening years beyond its initial scope and is now used to treat not only middle ear diseases, but also facial nerve disorders.1) Now large and chronic tympanic membrane perforations usually fail to heal. However, the possibility of repair suggests that it might be feasible to close even chronic and large TMPs by providing suitable conditions for growth and regeneration. Prof.Kanemaru developed TEES combined with regenerative treatment for tympanic membrane perforation using basic fibroblast growth factor (bFGF) , gelatin sponge and fibrin glue.2) Prof. Kakehata developed a facial nerve regeneration treatment for patients with severe Bell’s palsy (ENoG of 5% or less), in which a less invasive TEES was utilized. bFGF was applied to the tympanic segment of facial nerve, exposed via TEES, daily for 8 days through the drug delivery route which was made via TEES. 3) When confirming the ossicular fixation, the ossicular mobility is checked by touching them with the needle. This procedure is subjective and non-quantitative, as it is determined solely by the surgeon's feel transmitted. Therefore, there may be variation in the ossicular mobility value that surgeon decides that an ossicular reconstruction should be performed. Furthermore, the palpation must be performed without exerting significant pressure on the inner ear. However, it is not known how much pressure is applied to the inner ear by the palpation technique. Dr.Kanzaki investigated how much force is exerted on the inner ear by palpation of the ossicles affects the inner ear and the ossicular mobility to determine if ossicular reconstruction is performed.This panel demonstrates new development of TEES combined with growth factors andOUTCOME OBJECTIVE 1: We demonstrate that total closure of the perforation at 16 weeks was achieved in 75% in multicenter clinical trial. TEES combined with a tissue engineering therapy for tympanic membrane perforation is an easy, safe, cost-effective, and minimally invasive outpatient treatment.OUTCOME OBJECTIVE 2: The higher complete recovery rate of 46.4% (n=28) was obtained, especially 76.9%(n=13) in patients with an ENoG value of 1 to 5%. The results suggest that the administration of the bFGF, via the minimally invasive TEES offers a new approach to the treatment of intractable Bell's palsy.OUTCOME OBJECTIVE 3: Surgeon’s palpation is a greater force on the inner ear than expected. There is also any variation in the judgment of ossicular mobility among multiple surgeons in TEES. By mastering this technique, we can avoid inner ear damage and better judge the decision of ossicular reconstruction.BACKGROUND STATEMENT: We would like to introduce the cutting edge such as endoscopic ear surgical procedure of tympanic membrane and facial nerve regeneration treatment, and palpation of ossicles. This topic should contribute to audiences over the world.
Credits
CME:1.0, MOC:1.0