Endoscopic Management of Advanced Congenital Cholesteatoma

By June 7, 2019

Ma, Andrew1,2; Oh, Lawrence2; Saxby, Alexander1,2; Jufas, Nicholas1,2,3; Kong, Jonathan1,2,3; Patel, Nirmal1,2,3
1 Sydney Endoscopic Ear Surgery Research Group
2 University of Sydney
3 Macquarie University

Transcanal endoscopic ear surgery (TEES) is increasingly used in the management of appropriately selected cholesteatoma. Experience of congenital cholesteatoma (CC) managed primarily via TEES is presented.

Study Design: Retrospective chart review.
Setting: Tertiary referral centers.
Patients: Inclusion criteria were diagnosis of CC, and TEES approach (Class 2B and 3). Patients were operated on by four senior surgeons between 2014 to 2018. Exclusion criteria included presence of tympanic perforation, prior otologic surgery or trauma, presence of otorrhea, or chronic/recurrent otitis media with effusion. CC was graded according to the Potsic classification.
Intervention: Diagnostic and therapeutic

Main Outcome Measures: Primary outcomes were rate of recurrent and residual CC. Secondary outcomes were pre- vs. post-operative pure tone average (PTA).
Results: Twenty-four patients were included for review, comprising a total of 24 ears (14 left ears, 10 right ears). The average age was 13.4 years (2 – 76 years). The average duration of follow up was 16.5 months (range 0.5 – 52 months). Majority of CC were advanced (18 [75%] Potsic Gr 3-4, 6 [25%] Potsic Gr 1-2). There were no cases of recurrence. Residual CC was identified in 4 patients on second look surgery, a rate of 16.7%. OCR was attempted in 17 (70.8%) patients. Four cases (16.7%) required combined approach with mastoidectomy. There was a statistically significant difference between pre- vs. post-operative PTA (51.6dB vs. 27.9dB, p < 0.01). There were no significant intraoperative or postoperative complications reported.

TEES management of CC is associated with comparable recurrence rate to traditional microscopic approaches, even in cases of advanced CC.