By Arun Iyer, University Hospital Monklands, UK
COVID-19 has brought challenges in otology. This is partly because many otological procedures are aerosol-generating. There have also been difficulties in organising conferences and teaching due to travel restrictions and social distancing. Therefore, this webinar covering COVID- related difficulties, focusing on new technologies such as endoscopic and exoscopic ear surgery and other related topics, came as a real boon to many surgeons around the world, organised by Drs Daniel Lee, Michael Cohen and Alicia Quesnel from the Massachusetts Eye and Ear Infirmary, Boston, USA.
The programme was well organised to suit attendees from time zones around the world. The meeting started with a lecture by Dr Daniel Lee on ‘heads up surgery’ in otology, focusing on improved ergonomics of endoscopic and exoscopic techniques. It was followed by a keynote lecture by Prof Kakehata from Japan on ‘Innovation in Endoscopic and Exoscopic Ear Surgery’. The webinar had a very user-friendly platform where you could easily navigate between virtual conference rooms. The other useful discussions in the morning were on ‘The Role of Exoscopes in Otology and Neurotology – Are We Ready to Part Ways with the Microscope?’ chaired by Dr Sujana Chandrasekhar, and an ‘Update on Eustachian Tube Surgery’ by Prof Dennis Poe. The rest of the morning session was dedicated to tips on how to start endoscopic and exoscopic ear surgery, ergonomics in otology, live cadaveric dissection using endoscope as well as exoscope, with expert panel members from around the world. The lunchtime lecture by Alicia Quesnel on risk mitigation during ear surgery and the development of an ototent was very useful. 
There were further lectures on endoscopic anatomy by Prof Marchioni, tips on endoscopic cholesteatoma surgery, stapedectomy and ossiculoplasty. There were further cadaveric dissection sessions in the afternoon to accommodate viewers from different time zones. The futuristic lectures on ‘Novel Single-Use Disposable Distal Chip Endoscope Demo and Panel Discussion’ showed the recent developments in endoscopic technology. There were also some sessions aimed at trainees to address the practical aspects of endoscopic and exoscopic surgery.
On the whole, it was a very well-organised meeting, and I was impressed by the efficiency of the IT systems. In a way, many meetings in the future might adopt a hybrid model wherein the participants could attend either live or virtually. This way many more doctors will be able to attend the international meetings without leaving the comfort of their homes. The take-home message from the meeting was the fact that otology is changing with the advent of new technologies, such as high-definition cameras, endoscopes and 3D exoscopes, but it also highlighted the need for better ergonomics in the field of otology to reduce neck and back strain experienced by many surgeons. In future webinars, we should also find time for live questions and discussions, but this can prove to be difficult with more than 500 delegates attending. Another very useful point is the availability of the recordings of the lectures for participants so that they can revisit any particular topic as needed. 
