Incorporating the endoscope into middle ear surgery. 
We conducted a study to evaluate the use of a pediatric rigid otoendoscope for determining the extent of middle ear disease and for assessing ossicular integrity and mobility during tympanoplasty.  Our study population was made up of 132 patients who were undergoing surgery for the treatment of chronic suppurative otitis media; of this group, 41 patients underwent otoendoscopy and 91 underwent scutum lowering for purposes of visualization.  In the otoendoscopy group, the ossicles were successfully visualized and their mobility assessed in 34 patients; the remaining 7 patients subsequently underwent scutum lowering.  A 30 degrees endoscope allowed for complete visualization of the middle ear in almost all of the 34 cases.  The mean duration of surgery for the 34 patients in the otoendoscopy group was 62.85 minutes (+/- 15.57), which was significantly shorter than the duration of surgery (71.23 +/- 15.65 min) for the 98 patients who underwent scutum lowering (p < 0.005).  A total of 50 patients required less than 60 minutes of surgical time--26 of 34 (76.5%) in the endoscopy group and 24 of 98 (24.5%) in the scutum-lowering group.  Statistical analysis revealed that the possibility of completing a procedure in less than 60 minutes was 73.65% (+/- 12.56%) when endoscopy was used and 58.62% (+/- 12.60%) when scutum lowering was used--again, a statistically significant difference (p < 0.005).  We conclude that incorporation of an angled otoendoscope into middle ear surgery is a worthwhile alternative to scutum lowering.