Endoscopic Ear Surgery in Children and Adolescents

By June 7, 2019

Langer, Joerg1; Pethe, Wolfram1
1 ENT Department, AMEOS Clinic Halberstadt, Germany

Cholesteatoma surgery in children still poses a challenge to the surgeon nowadays.
Due to the aggressive behavior of primary cholesteatomas a relatively extensive surgery is required.
In order to be able to maintain important anatomical structures and possibly perform a Canal Wall up-technique, the use of endoscopes has proven itself. Especially at the chordo-facial angle or in the antrum, microscopic ear surgery reaches its limits.

Since 04/2015, 19 surgeries have been performed in 13 patients under the age of 18 using the endoscope. Primarily the operation was done with a microscope. The endoscope was used to control the surgical site and, if necessary, residual cholesteatoma was removed endoscopically (EES 1 to EES 3).
Second look surgeries were performed in 4 children, In one case two additional surgeries took place according to defects in the tympanic membrane.
No case of second look showed a recurrent cholesteatoma.
The median age at surgery was 8.4 years. The follow up period is 31.8 months.

The use of endoscopes is a useful supplement to the microscopic surgery to be able to reliably detect and remove any remaining cholesteatoma matrix after microscopic ear surgery.

Based on the results of scheduled second-look operation without cholesteatoma recurrence our surgical procedure has changed. Second-look surgeries seem to be indicated only in case of clinical suspicion of recurrent cholesteatoma.