Value of ear endoscopy in cholesteatoma surgery.

OBJECTIVE The purpose of this study was to assess the value of ear endoscopy in cholesteatoma surgery and to demonstrate its consequence in improving surgical outcome. MATERIALS AND METHODS A total of 92 ears with acquired cholesteatoma (primary or secondary) were operated on. In this prospective study, 82 cases were operated on by using canal wall up (CWU) technique, and 10 cases were on operated on by using canal wall down (CWD) procedure. Endoscopically guided ear surgery was incorporated complementary to the microscope as a principal part in the procedure. Second-look endoscopic exploration was performed on some selected cases, depending on the finding during the primary surgery and the postoperative findings of clinical and computed tomographic studies. RESULTS In the primary surgery after completion of microscopic cleaning, the overall incidence of intraoperative residuals detected with the endoscope was 22.8%. Sinus tympani was the most common site of intraoperative residuals in both CWU and CWD groups, followed by the facial recess and the undersurface of the scutum in the CWU cases. Reconstruction of the hearing mechanism was performed in the primary surgery in 86 cases (93.5%) and postponed to the second stage in only six cases (6.5%). Out of the 82 CWU cases, 35 second-look endoscopic explorations (42.7%) were performed. Three recurrences (8.6%) were identified. Two cases showed a tiny residual cholesteatoma pearl, and the third showed a larger open residual cholesteatoma filling the sinus tympani and extending to the aditus. In this series, no morbidity or complication was encountered secondary to the use of endoscopes in the mastoid or middle ear. CONCLUSION Incorporating the endoscope into the surgical armamentarium in otology contributes much to the concept of minimally invasive surgery. Minimally invasive endoscopic ear surgery should be accepted as a new horizon in ear surgery. In this study, it became obvious that despite the use of the endoscope in conjunction with the operating microscope, 100% eradication of the disease still could not be achieved; however, the use of endoscopes did reduce the residual cholesteatoma rate.