Clinical Outcome of The Endoscopic Ear Surgery for Pars Tensa Cholesteatoma

By June 7, 2019

Ito, Tsukasa1;Kubota, Toshinori1; Furukawa, Takatoshi1; Matsui, Hirooki1; Futai, Kazunori1; Kakehata, Seiji1
1 Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.

To improve surgical outcomes for cholesteatomas, we use either an endoscope alone as part of transcanal endoscopic ear surgery (TEES) or endoscope-assisted microscopic surgery. We have further employed an ultrasonic aspirator to extend the indications for TEES to treat cholesteatomas and collected data on clinical observations for pars tensa cholesteatomas.

Study Design: Prospective case series.
Setting: University hospital.
Patients: Forty-five patients who underwent endoscopic surgery to treat pars tensa cholesteatoma between September 2011 and December 2016 (mean age/range: 57 yr/6–83 yr; 21 male/24 female; mean follow-up/range 38 m/1–78 m).
Intervention: Patients underwent either TEES or endoscope-assisted microscopic surgery.

Main Outcome Measures: We collected data on clinical staging based on the EAONO/JOS joint consensus statements, surgical procedures and surgical outcomes. (EAONO: European Academy of Otology and Neurotology, JOS: Japanese Otological Society)
Results: The cholesteatoma was localized in the tympanic cavity in 6 ears (13%); extended beyond the tympanic cavity in 26 ears (58%); and associated with extracranial complications in 13 ears (29%). TEES was performed in 37 ears (82%) with cholesteatomas extending up to and including the antrum. Canal wall up or canal wall down mastoidectomies were employed in 2 ears (4%) and 6 ears (13%) respectively for severe cholesteatomas. Twenty-two patients had a postoperative air-bone gap of less than 20 dB and a residual cholesteatoma was found in 4 patients among 41 patients over a one-year follow-up period.

TEES with an ultrasonic aspirator achieved overall favorable outcomes for pars tensa cholesteatomas without perioperative complications.