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Endaural Laser-Assisted Single-Stage Inside-Out Cholesteatoma Surgery (LASIC) to Treat Advanced Congenital Cholesteatoma

Lee, Chang Ho; Kim, Mi Kyung; Kim, Hyoung-Mi; Won, Cheongse; Shin, Tae Hyun; Kim, So Young

doi: 10.1097/MAO.0000000000002299

Objectives: Investigation of endaural laser-assisted single-stage inside-out cholesteatoma surgery (LASIC) to treat advanced congenital cholesteatoma (ACC) by a modified staging system based on ossicle status.

Study Design: A retrospective case review.

Setting: A university hospital otology referral clinic.

Patients: Two hundred consecutive pediatric patients with ACC were enrolled.

Interventions: Endaural LASIC and postoperative temporal bone computed tomography (CT).

Main Outcome Measures: Residual or recurrent CC and audiological outcomes.

Results: LASIC was feasible in 98.0% of patients. Single-stage ossiculoplasty was performed in 95.5% of patients. Hearing preservation to less than 20 dB was 59.2% and to the preoperative hearing level was 84.5%. Mastoid invasion did not result in worse recidivism or hearing loss (HL) but further invasion of the stapes superstructure (stage IV) significantly elevated both the recidivism (16.7%) and the risk for HL (to 84.8%) (p = 0.001). Ossicle preservation LASIC was frequently possible in stage III posterior type (75.6%), whereas it was rarely possibly (15.4%) in the anterior type. Incudostapedial joint (ISJ) invasion in the absence of cochleariform process (CP) invasion (III-posterior) did not increase the incidence of HL (6.1%) or recidivism (2.4%). However, simultaneous invasion of the CP and ISJ (III-anterior) elevated the risk of HL by 46.2% by ossicle removal, although recidivism was not increased (3.8%).

Conclusions: Endaural LASIC for ACC achieved satisfactory recidivism (overall 7.5%, 16.7% in stage IV) comparable to early CC (17.2%). An ossicle status-based staging system was more efficient for correlation with audiologic and surgical outcomes of CC than that of mastoid invasion.

Department of Otorhinolaryngology–Head and Neck Surgery, CHA University College of Medicine, Seongnam, Gyeonggi-do, Republic of Korea

Address correspondence and reprint requests to So Young Kim, M.D., Department of Otorhinolaryngology–Head and Neck Surgery, CHA University College of Medicine, 59, Yatap-ro, Bundang-gu, Seongnam, Gyeonggi-do 13496, Republic of Korea; E-mail:

Funding: This work was supported in part by a research grant (NRF- 2018R1D1A1B07048092) from the National Research Foundation (NRF) of Korea. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

The authors disclose no conflicts of interest.

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