Endolymphatic decompression cannot be performed by otoscopy at this time.
Endolymphatic sac decompression is indicated for patients with membranous labyrinthine effusion who have been treated conservatively for more than 1 year and still have frequent episodes of vertigo and practical hearing in the affected ear. To date, it is still the main option to perform the procedure with a 6- to 10-power operating microscope using conventional ear microsurgical instruments.
The endolymphatic sac is located between two layers of dura mater in the lower half of the posterior cranial fossa. When viewed from the side, the endolymphatic sac is surrounded by the vertical segment of the facial nerve anteriorly, the sigmoid sinus posteriorly, the posterior semicircular canal anteriorly and superiorly, and the jugular vein bulb inferiorly. Surgery in this zone requires precise bone grinding and detailed operations such as probing and identification under direct vision.
An otoscope that reaches the extent of the anatomical region of the endolymphatic sac needs to be viewed via an intraauricular pathway. However, no accurate and constant reference markings have been established at this stage to ensure the safety and standardization of surgical operations.
If endolymphatic sac decompression is required, microscopic surgery is still recommended at this stage, and specific requirements can be obtained from the attending surgeon.