Dear Sir, According to the literature, a major limit of endoscopic ear surgery is bleeding. When it does occur, the surgeon is sometimes forced to interrupt or convert to an oto-microscopic, a bi-manual procedure [1–3] . Senior surgeons are accustomed to use one hand for suction and the other to maneuver instruments within the EAC (external auditory canal), due to traditional oto-surgical training. This allows maintaining the tiny operative field within the ear canal clear from blood. In our experience, bleeding was never a relevant issue both in ventilation tube placement  and endoscopic tympanoplasty: in no instance did the procedure become so demanding and troublesome that it had to be converted to a microscopic intervention. In case of a bloody field, especially in hyperplastic mucosa during the elevation of the fibrous annulus the application of a sponge soaked with a vasoconstrictor such as epinephrine 1:100,000 or pseudoephedrine 1% for a few minutes allowed adequate hemostasis. Rinsing the ear canal with warm saline solution also helps to reduce bleeding and clear the field. A very helpful hint that offers a less bloody field is that the procedure should be started by incision and elevation of the meatal flap.
International Journal of Pediatric Otorhinolaryngology – Elsevier
Published: Jan 1, 2016
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