Color Atlas of Otology: Diagnosis and Management

Review by L Flood
Middlesbrough, UK

There has been many an atlas published in our speciality. No fewer than ten titles carrying this claim have been reviewed in this journal since 2020. Any atlas must then be judged by its novelty and, above all, by the quality of the images presented. Still photography of otologists surgery is challenging. The side arm of the traditional operating microscope is relatively inefficient as a photographic tool, which is no surprise in what is a deep dark cavity, with depth of field particularly hard to capture, whether on film or, nowadays, digital media. Video carries a better impression of the 3D surgical field and the otoendoscope, married up to the digital camera has transformed the transcanal view.

The challenge is very apparent in places in this atlas, with some illustrations showing every tiny blood vessel sharply. Some however, most notably in chapter 15 on stapedectomy, fail, where eleven successive stages can hardly be distinguished, as so dark and almost lacking any obvious content.

There are 96 pages of widely spaced text and coloured photographic illustrations. The opening 30 pages cover diseases of the ear and, being mostly otoendoscopic are of good quality. I am not sure that we need four portrayals of insects in the ear, followed by four of foreign bodies. Retractions, perforations and cholesteatoma are to be expected. Many pictures carry superimposed lettering to label structures seen, but, in some cases, actually obscure them. A second edition might be wiser to print each of such images twice, without and then with the labelling. I was impressed by the quality of the tuberculous otitis media photograph showing multiple perforations, but also by what can be captured on still film.

Section B follows with nearly 50 pages on “Surgeries of the Ear”. For each procedure there is some text describing the surgical steps required, accompanied by illustrations of varying quality. Surprisingly, ossiculoplasty proved a very photogenic topic. In contrast mastoidectomy is characterised by very dark and indistinct illustrations, which again I think might have made great videos. My greater concerns about the stapedectomy chapter I have already expressed above. A chapter on CT scanning in cholesteatoma nicely shows examples of advanced disease. Whether it has any influence on management, as many (but not this reviewer) would doubt, is not discussed. A final chapter on “Post Surgical Evaluation and Complications” comprises some nice endoscopic portrayals of failed reconstructions and extruding prostheses, with some limited discussion in the captions.

Operative manuals in otology are probably better portrayed with line diagrams, accompanied by videos (or live streaming at a training course), than by still photography. That the tympanic memebrane and cavity is an ideal subject for the otoendoscopic camera is evident here. The challenge even then is still to introduce some novelty into a crowded market and that is not easily met.

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