In 2016, Brandon Isaacson, M.D., with the help of neurosurgeon Sam Barnett, M.D., performed the first invisible acoustic neuroma surgery in the U.S. Since that time, UT Southwestern has become a popular referral center for this and other transcanal endoscopic ear surgeries (TEES). Having performed hundreds of the procedures, Dr. Isaacson skillfully applies the endoscopic approach to many scenarios, from routine tympanoplasties to more complicated cholesteatomas.

Like most minimally invasive surgical techniques, TEES involves a smaller incision, faster recovery time, and less pain for patients. It also doesn’t require pulling the ear forward and removing bone to expose the ear canal and middle ear, as in traditional postauricular microscopic surgery. From the surgeon’s perspective, the endoscope also provides a better view of the recesses of the ear, though with less depth perception than a microscope.

“TEES are a little more challenging to pick up than traditional techniques,” said Dr. Isaacson, Professor of Otolaryngology - Head and Neck Surgery. “Using a microscope, both hands are free to work. The endoscope has to be held in your nondominant hand, so you just have one hand to hold your surgical instruments. And you have to get used to viewing the ear on a screen, instead of right in front of you.”

Dr. Isaacson and his fellow adult neurotologists in the Department of Otolaryngology - Head and Neck Surgery, Walter Kutz, M.D., and Jacob Hunter, M.D., each complete five to 10 ear surgeries a week, with about 70 to 80% endoscopic. They, along with Kenneth Lee, M.D., Ph.D., also use TEES in pediatric patients. Procedures such as cochlear implants and the removal of large lateral skull base tumors aren’t well suited to TEES, but many of the more common procedures are, like myringoplasties and stapedectomies. “Many cholesteatomas can also be removed endoscopically,” said Dr. Isaacson, “and we can even correct complex congenital middle ear malformations using this technique.”

Clinicians in the Department of Otolaryngology - Head and Neck Surgery are currently gathering data to verify their observation of better outcomes for patients undergoing TEES compared with open, postauricular surgeries.

Dr. Isaacson teaches TEES to surgeons through the International Working Group on Endoscopic Ear Surgery. Several surgeons at Children’s Medical Center Dallas perform TEES on pediatric patients, including Dr. Lee, Gopi Shah, M.D., Christopher Liu, M.D., and Ashley Agan, M.D.

Drs. Isaacson, Barnett, Kutz, and Hunter are members of UTSW’s Peter O’Donnell Jr. Brain Institute.