Congratulations to Dr. Kozin et al. for their recent publication regarding a transcanal osteotome technique with endoscopic visualization for removal of ear canal exostoses.

I concur that a transcanal approach for this operation has a number of advantages for the patient compared to a post-auricular approach (less dissection through normal skin, muscle and sensory nerves).

The lamellated character of exostoses enhances the safety of using an osteotome, in that plates of bone tend to separate when an osteotome is used, and in many instances it is not necessary to advance the tip of the osteotome to the end of the bone layer in order to have separation of a segment of bone.

The transcanal approach for exostosis removal can be done with a binocular microscope, or, as demonstrated in Dr. Kozin’s paper, an endoscope. An endoscope with an angulated tip may allow a better view around an obstructive exostosis than the binocular microscope. However, the limitations of the endoscopic technique include the need for additional hands to hold the endoscope while the surgical area is being visualized; the need to fit instruments around the endoscope; and the potentially injurious heat of the tip of the endoscope.

Is Dr. Kozin aware of any devices that can hold the endoscope and its attached camera in a fixed, stable position and thereby lessen the need for an assistant to hold the endoscope?