Yamagata University Hospital

Transcanal Endoscopic Ear Surgery

Transcanal Endoscopic Ear Surgery (TEES)


The department developed the world-leading Transcanal Endoscopic Ear Surgery (TEES) using a rigid endoscope, a keyhole operation that uses the external auditory canal as an access route to the inner ear, and currently we're working to improve it. TEES is a minimally invasive and safe operation, leaving no scar visible from the outside, and almost no postoperative pain.

Until the 1950s when inner ear operations began to be performed under a microscope, procedures were performed with the unaided eye. In 1953, Wullstein announced the tympanoplasty, marking the dawn of the age of modern otologic surgery. Even now, preauricular and postauricular procedures using microscopic ear surgery (MES) are typically performed making an external incision. With microscopic surgery, it's necessary to drill a wide opening in the bone to ensure a good view of the lesion and ample working space, but nonetheless anatomical blind spots may still exist, which lead to residual lesions.

TEES is Totally Endoscopic Ear Surgery, in which almost all processes of middle ear surgery are performed endoscopically through the ear canal. The operation, which aims to restore physiological function, is minimally invasive and it can be performed safely with full visibility. TEES is suited to most diseases of the inner ear that were hitherto operated on microscopically, including chronic otitis media, cholesteatoma of the middle ear, stapes surgery, and middle ear malformation.

TEES has so far been limited to the epitympanum in advanced cases, but our department has developed powered TEES using ultrasonic surgical apparatus and a curved bar that can drill bone with one-handed operation for simultaneous washing and aspiration, expanding the scope of application of TEES.

The fact that TEES enables surgical procedures with no blind spots is a boon not only for practitioners but also for patients.

Results for Otologic Surgeries in 2015

Total number of otologic surgeries: 124
TEES (endoscopic surgeries): 99

The breakdown for each disease:

Cholesteatoma of the middle ear (including congenital, acquired, and recurrent)
Tympanoplasties: 60 (including 36 endoscopic surgeries)
Chronic otitis media
Tympanoplasties: 37 (including 36 endoscopic surgeries)
Myringoplasties: 20 (all endoscopic surgeries)
Stapes surgeries: 7 (all endoscopic surgeries)

Surgical Treatment for Acquired Cholesteatomas