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Transcanal Endoscopic Ear Surgery for Middle Ear Cholesteatoma

Glikson, Eran*; Yousovich, Ruth*; Mansour, Jobran*; Wolf, Michael*,†; Migirov, Lela; Shapira, Yisgav*,†

doi: 10.1097/MAO.0000000000001395
MIDDLE EAR AND MASTOID DISEASE
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Objective: To evaluate the clinical parameters, outcomes, and complications of transcanal endoscopic ear surgeries for middle ear cholesteatoma.

Study Design: Retrospective study.

Setting: Tertiary university-affiliated medical center.

Patients: Adult patients (age >18) who underwent transcanal endoscopic ear surgeries for cholesteatoma, between March 2009 and March 2015.

Intervention: Transcanal endoscopic surgery was indicated when the cholesteatoma did not extend posterior to the anterior limb of the lateral semicircular canal. Rigid endoscopes 4 and 2.7 mm in diameter, 0, 30, 45, and 70 degrees were used with angled picks, suction, and forceps.

Preoperative assessment included high-resolution computed tomography of the temporal bones and/or non echo-planar diffusion-weighted magnetic resonance imaging and pure-tone audiometry.

Main Outcome Measures: Residual or recurrent disease was diagnosed by clinical examination and/or magnetic resonance imaging findings consistent with cholesteatoma. Intra- and postoperative complications, pre- and postoperative audiometric results were recorded.

Results: Sixty operations (56 patients, mean age = 43.6) were included.

Six operations (10%) were performed under local anesthesia. The most common sites of cholesteatoma involvement were: posterior epitympanum (n = 51, 91%), anterior epitympanum (n = 19, 33.9%), posterior mesotympanum (n = 13, 23.2%), and sinus tympani (n = 11, 19.6%). Intraoperative ossicular chain reconstruction was performed in 18 (30%) cases.

Our overall residual and recurrence rates were 10% (n = 6) and 8.3% (n = 5), respectively, with mean duration of follow up of 35 months. The most common sites of residual disease were the mastoid cavity/antrum (n = 3, 50%), tympanic cavity, and posterior mesotympanum. Overall minor and major complication rates were 16.6 and 6%, respectively.

Conclusions: Transcanal endoscopic ear surgery was found to be an acceptable and safe technique for the exposure and eradication of middle ear and/or attic cholesteatoma.

*Department of Otolaryngology, Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Address correspondence and reprint requests to Eran Glikson, M.D., Department of Otorhinolaryngology–Head and Neck Surgery, Chaim Sheba Medical Center, Tel Hashomer, 5262100, Israel; E-mail: Eran.Glikson@sheba.health.gov.il

Funding: None.

The authors disclose no conflicts of interest.

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