Ear Surgery Illustrated: A Comprehensive Atlas of Otologic Microsurgical Techniques

Review by L Flood
Middlesborough, UK

I felt I would have to like this book and fortunately I really did, but only after a moment’s hesitation. The author is not just a surgeon of international repute, for many years a very able editor of Otology and Neurotology and a good friend to The Journal of Laryngology & Otology, but also a very amiable and down-to-earth person. I will then confess to a moment of disquiet as I opened the book. By pure mischance, I was faced with two A4 pages that were almost blank. A single small colour drawing on each was accompanied by a large grey text box, but with only one line of text in each. Fortunately that proved an exception, but I really had wondered if there had been a printing error.

No, I should have read the subtitle. This is an atlas of illustrations and so is presented in a very different format to the traditional surgical textbook. I am glad to be able to say it really does work. Procedures are delightfully presented in a stepwise fashion, with many a pearl of wisdom. To quote the Preface, ‘The emphasis of this book is upon the illustrations, with text limited to a concise description of operative techniques – the concept is to let the illustrations speak for themselves’. I was soon convinced that such high-quality coloured drawings beat the best operative still photography.

In nearly 500 pages and over 1000 illustrations, the author then covers topics as diverse as exostosis surgery (if only it was as easy as suggested), facial nerve repair, temporal bone resection and stapes surgery. A superb early chapter is entitled ‘Fundamentals of Ear Surgery’, filled with things most of us learnt the hard way. It offers references for further reading and even cites UK journals. Nine A4 pages illustrate optimal positioning of the patient, with little need for text, in practice, to convey the message. Even better is ‘Microinstrument Hand Positioning’, the dos and don’ts of holding a speculum or drill, followed by ‘Ergonomics’. Six illustrations show where we go wrong as we sit to operate, and suffer the aches and fatigue that result. I do recognise the ‘otologic slouch’, a great term to describe a posture all too familiar. The stepwise illustrations of the post-auricular and endaural incisions make for the best tuition I have seen of these approaches, other than hands-on cutting.

From the simplest to the most advanced surgery, the illustrator’s skill is evident. A classic example is the simple cortical mastoidectomy, where every sagittal (the surgeon’s) view is accompanied by an axial equivalent to show the depth reached. I do think the sigmoid sinus haemorrhage in Fig. 7.49 is a bit optimistic, however!

It finally dawned on me that the illustrated atlas concept was the ‘go to’ for the UK trainees of the 1970s. One constantly referred to Rob and Smith’s Operative Surgery; The Ear, and that was not then in its fourth edition of 1998. We got far fewer monochrome line diagrams, and little text, but relied on that book. The publishers tell us ‘This richly illustrated ear microsurgery atlas shows a picture is worth a thousand words!’. I would agree and feel this book is a treasure for the trainee, but also filled with useful tips for the most experienced senior.

Amazon Link: Ear Surgery Illustrated: A Comprehensive Atlas of Otologic Microsurgical Techniques
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