Approach to the Inner Ear by “Underwater” Endoscopic Ear Surgery: Its Utilization and Prospects

  • Daisuke YamauchiEmail author
  • Yohei Honkura
  • Yosuke Hara
  • Jun Ohta
  • Hiroshi Hidaka
  • Yukio Katori


We propose a novel technique—“underwater” endoscopic ear surgery (UWEES)—for preservation of inner ear function, especially in patients with a labyrinthine fistula, cochlear implantation, or other conditions requiring inner ear surgery. This technique provides a clear operative field without the need for suction and protects the inner ear from unexpected aeration that might lead to functional damage. The mastoid cavity or external auditory canal is filled completely by perfusion with saline or Ringer’s solution. The perfusate is delivered through a lens cleaning sheath covering an endoscope, thus providing a clear surgical field without reflection or refraction artifacts. This chapter describes the concept and indications for UWEES, the preparations that are necessary, the operative technique (including tips), cases we have treated, and details of training and possible future applications.


Labyrinthine fistula Chronic otitis media Cochlear implantation Drug delivery system Endoscopic ear surgery Underwater 



We are grateful to Dr. Takuya Ito and Yuko Iki for support at Tohoku University Hospital Advanced Medical Training Center. This work was supported by KAKENHI (16K11171).

Conflict of Interest and Financial Disclosure

The authors have no funding, financial relationships, or conflicts of interest to disclose.


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Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Daisuke Yamauchi
    • 1
    Email author
  • Yohei Honkura
    • 1
  • Yosuke Hara
    • 1
  • Jun Ohta
    • 1
  • Hiroshi Hidaka
    • 1
  • Yukio Katori
    • 1
  1. 1.Department of Otolaryngology-Head and Neck SurgeryTohoku University, Graduate School of MedicineSendaiJapan

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