Basic principles of endoscopic ear surgery

The wide-angle and high-resolution image afforded by endoscopes allows for improved visualization of ear anatomy compared to the operative microscope. Incorporating the endoscope into otologic practice, however, is challenging. A graduated and stepwise introduction of endoscopic ear surgery (EES) into an established otologic practice is recommended to ensure safe and successful implementation. In this article, we discuss (1) rationale for use of the endoscope in ear surgery, (2) indications, (3) surgical ergonomics, (4) relevant instrumentation for EES, and (5) pearls and pitfalls of transcanal EES approaches.