Concept and Realization of a Handheld Manipulator System for Transnasal Middle Ear Surgery

In the context of conductive hearing loss and pathologies of the ossicular chain, invasive procedures are necessary for inspection and treatment. We propose a handheld manipulator concept for the palpation of the ossicles under endoscopic view. The system can access the middle ear through the Eustachian tube without any incision thanks to its small cross-section. Virtual verification tests conducted using medical image data of 30 patients regarding the workspace of the manipulator showed that malleus, incus and stapes can be reached in 83%, 90% and 63% of the cases respectively. Tests regarding manipulation forces showed that the system can apply -0.95 N traction force and 0.80 N compression force, which are sufficient for the palpation task according to the literature.