Comparative Analysis of Transcanal Endoscopic Ear Surgery (TEES) and Hybrid (Endoscope assisted) Procedures for Cholesteatoma Resection

By June 7, 2019

Totten, Douglas1; Manzoor, Nauman2; Rivas, Alejandro2
1 Vanderbilt University School of Medicine, Nashville, TN, USA;
2 Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA.

Endoscopic approach provides access to difficult-to-visualize portions of the middle ear space (such as the sinus tympani and anterior epitympanum) and has been increasingly used in cholesteatoma resection. The goal of current study is to compare clinical, disease and audiometric outcomes of TEES and hybrid approaches at a single institution.

– Study design: Retrospective (2015-2018)
– Setting: Tertiary otology-neurotology referral center
– Patients: 65 patients with mean age 29 years (SD: 21.8, range: 3-80) underwent primary intervention.
– Intervention: TEES and hybrid (microscopic-endoscopic) approach was used in 30 and 35 patients respectively.

– Main Outcome Measure(s): Residual/Recurrent cholesteatoma, audiometric outcomes, operative time
– Results:
There was a significantly higher use of second look operations in the hybrid cohort compared to TEES, (42.9% versus 13.3%, p=0.009). There was no significant difference in the rate of residual/recurrent cholesteatoma (hybrid=25.7% compared to TEES=20%, p=0.586).  Disease in the hybrid group was significantly more extensive compared to TEES (Attic=82.9% versus 30%, Mastoid=77.1% versus 10%, Retrotympanum=82.9% versus 26.7%, p<0.05). Post-operative air-bone gap (ABG) following hybrid cases was significantly higher compared to TEES (21.2 dB versus 15.1 dB, p=0.04). Operative duration of TEES was significantly less than hybrid cases (TEES=162 min, SD: 51; Hybrid=241min, SD: 76; p<0.001).

There is no significant difference in disease related outcomes (recurrence/residual cholesteatoma). TEES can be used in less extensive disease with similar disease outcomes to traditional microscope driven procedures with a reduction in operative time and need for second look procedures.