Middle ear imaging using virtual endoscopy and its application in patientswith ossicular chain anomaly

Virtual endoscopy (VE) is a recently developed technique to provide a reali stic surface rendering of various organs, which can be applied to the use o f three-dimensional (3D) studies of several lesions. However, its advantage s in otological disease have not been well investigated. in this study, we evaluated the application of VE in patients with ossicular chain anomalies. Virtual middle ear endoscopy was a time-saving method, however, we needed the appropriate technical procedures of algorithm and reconstruction spacin g to generate accurate 3D images of ossicles. We obtained virtual surgical views of middle ear structures and related anomalies, and confirmed by intr aoperative findings that these images were mostly compatible with the actua l lesions of ossicles, VE allowed an identification of the anatomy of the o ssicles and adjacent structures simultaneously. The elements of the stapedi al crura were clearly visualized with VE images in 93.3% of normal ears. Pa thological ossicular chain findings such as malleus or incus fixation, disl ocation and disruption, except footplate fixation were investigated success fully. One possible procedure, using alterable CT value in the obtained VE images on the monitor, is proposed for further detection of fine lesions of the ossicles. These observations suggest that virtual middle ear simulatio ns accurately represent major intraoperative findings. This technique may h ave an important role in preoperative planning, surgical training, and/or p ostoperative evaluation in otology, Copyright (C) 2000 S. Karger AG, Basel.