Exploring the Middle Ear
NATIONAL JOURNAL OF HOMOEOPATHY 1996 May / Jun Vol V No 3.
Sunanda Khanna.
EXPLORING THE MIDDLE EAR: Uses of tele-endoscopes in diagnosing and remedying disorders of the ear.
Examining the ear is never an easy task and exploring it surgically is fraught with problems. There is the constant fear of something going wrong and leading to disastrous complications.
Until very recently the best hope for a patient suffering from Acoustic neuroma was an operation which involved the opening up of his brain in order to reach the target area. Acoustic neuroma is a tumour which affects the nerve going from the ear to the brain. Essentially the tumour is part in the brain and part in the ear. Till recently, these cases were handed by the neurosurgeon.
But "diseases that harm call for treatments that harmless". And with the relatively nascent discipline in India called oto-neurosurgery, "the success rate is phenomenal.", says Dr N L Hiranandani of the BYL Nair Hospital, Mumbai. Here the ENT surgeon and the neurosurgeon work in tandem using the latest techniques in the field. The former drills the ear bone above the tumour without touching the brain tissues. This cause no pain after surgery as there is no nerve supply in the bone. The neurosurgeon steps in thereafter to remove the tumour through the opening carved out by the ENT surgeon.
The entire process is smooth and safe and the postoperative period is also much shorter. In fact, the neurosurgeon can fruitfully utilise the tele-endoscope which is yet another advancement in the technique of micro surgery. It was demonstrated for the first time in India by French otoneurosurgeon Dr Andre Sultan at a recently concluded workshop at Mumbais Nair Hospital.
With this device in hand the doctor can go right into the nooks and corners of the ear and examine new areas which are otherwise not possible and difficult to reach. All this he does without making much of an incision. The patient sits in a chair and watches on a closed-circuit television as the doctor goes about his job.
But Dr Hiranandani explains that most of the cases which "come to us are of large-sized tumour. Here the tele-endoscope for the ear or the oto-endoscope as it is known, is not of as much use as it would be to a micro surgeon who is handling much smaller tumours. The operating microscope is more suited to us." Adds Dr D s Grewal, head of ENT department, Nair Hospital, "it also leaves our hands free to work.".
However, this is no way dims the importance of this latest invention which is a new addition even for French surgeons. Many patients who attend the ENT OPD complain of a continuous ear discharge caused by an infection in the middle ear known as cholesteatoma. This disorder has an alarmingly high incidence in India. Surgery is not foolproof because the infection often recurs.
The oto-endoscope can help remove the last vestiges of the disease from th crevices of the ear. It also enables the surgeon to find out if the problem has recurred or not. "It helps us to predict and know what to expect," says Dr Mistry at Nair.
Dr Grewal and Dr Hiranandani explain that in India "We encounter ear diseases in a late stage, leading to extensive destruction of the hearing apparatus. These complications are not commonly seen in the western countries where diseases are detected at an early stage".
