Transtympanic endoscopy for diagnosis of middle ear pathology.

Office-based transtympanic endoscopy through the perforation made by laser-assisted myringotomy (LAM) has been introduced for diagnosis of ossicular interruption, stapes fixation, tympanosclerosis, congenital cholesteatoma, and perilymphatic fistula. Endoscopy of the middle ear reveals minor anomalies around the incudostapedial joint and the superstructure of the stapes. This procedure can be also applied to diagnose stapes fixation and perilymphatic fistula not diagnosed presurgically, and requires exploratory tympanotomy to make a definite diagnosis. Transtympanic endoscopy using LAM is a direct and reliable preoperative diagnostic method for abnormalities of the middle ear, offers better surgical indications and patient consultation, and is a potential alternative to exploratory tympanotomy.