EVALUATION OF ENDOSCOPIC SURGERY FOR MIDDLE EAR CHOLESTEATOMA

Abstract

Background: Endoscopy as a new tool in ear surgery is showing increasing benefit in cholesteatoma surgery. During ear surgery, the use of endoscopes facilitates the eradication of cholesteatoma in areas difficult to visualize with the operating microscope. Management of limited attic cholesteatoma with total transcanal endoscopic ear surgery is a new era in otology providing less invasive type of surgery. In extensive cholesteatoma surgery, the complementary use of endoscopes guarantees better disease control. Aim of work: To solve the problem of recurrent and residual cholesteatoma via application of endoscopes and video systems which provide better visualization through panoramic view and better control of hidden areas with aid of angled endoscopes. Patients and methods: This study was applied on 73 patients that have middle ear cholesteatoma. They are subdivided into 31 cases who have limited attic cholesteatoma operated upon using total transcanal endoscopic approach. And 42 cases with extensive cholesteatoma operated upon using endoscopic assisted canal wall up approach. Eradication of cholesteatoma was established, reconstruction of ossicles was performed when indicated and reconstruction of the outer attic wall and tympanic membrane were performed for all cases. All patients were exposed to full preoperative evaluation, and full postoperative assessment of attic retraction, recidivistic disease, and the hearing gain expressed by the change of the air bone gap postoperatively. Results: Cholesteatoma surgery performed successfully with total transcanal approach in 42.5% of cases. The incidence of cholesteatoma in the facial recess that was visualized by the endoscope was (26%) compared with (20.5%) by the microscope with no significant difference (p=0.134), whereas the incidence of cholesteatoma in the sinus tympani visualized by the endoscope was (37%) compared with (12.3%) by the microscope, with a high significant difference (p<0.001). Cholesteatoma in the anterior epitympanic space was detected by the endoscope in (15.1%) of ears compared with (0%) by the microscope with a statistically significant difference (p= 0.003).Conclusion: introducing the endoscope into the otologic surgical field is a step forward, as it provides a wide field of vision with minimal dissection, exploring hidden areas of the middle ear cavity with much lesser requirement for surgical dissection and the need to drill healthy bone; therefore, effective control over the disease can be achieved with establishment the concept of „functional endoscopic ear surgery.‟
Keywords: limited attic cholesteatoma, total transcanal endoscopic ear surgery, recidivism.