endoscopic middle ear and mastoid surgery for cholesteatoma

introduction: to reduce incidence of residual cholesteatoma following ear surgery; and to reduce the need for second look “open” mastoidectomy using endoscopic mastoidotomy. ten-year retrospective chart review of 249 primary cholesteatoma cases (1994-2004) with a minimum follow-up of two years.  the first objective was to evaluate the effectiveness of otoendoscopy in reducing the incidence of “cholesteatoma remnant” at the time of primary surgery. the second investigation was to evaluate the effectiveness of otoendoscopy in reducing the need to open the mastoid cavities during “second look operations”.         materials and methods: endoscopes were used on all cases as an adjunct to standard microscopic methods. once all visible cholesteatoma was removed with standard microscopic techniques, endoscopes were utilized in order to identify any “remnants” of cholesteatoma. endoscopes were also employed during revision second look cases in order to allow the evaluation of intact canal wall mastoid cavities without an open mastoidectomy approach.   results: endoscopy at time of primary operations revealed a 22% incidence of hidden cholesteatoma “remnants” despite apparent total microscopic eradication in closed cavity  cases, and 10% in open cavity patients.  endoscopic removal of cholesteatoma remnants reduced the long term cholesteatoma “residual” to 9.7% in closed cavity patients. furthermore, endoscopic surgery significantly reduced the need to open the mastoids during second look operations.     conclusion:  otoendoscopy is a very effective adjunctive method in ear surgery. it allows significant reduction in cholesteatoma residual rate in both closed cavity and open cavity cases.  furthermore, the great majority of second look mastoids can be evaluated endoscopically and thus avoid an open revision mastoidectomy.