Endoscopic Management of En Plaque Cholesteatoma associated with Tympanic Membrane Perforation

By June 7, 2019

Ma, Andrew1,2; Rao, Amshuman2; 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

En plaque cholesteatoma (EPC) describes cholesteatoma occurring on the medial surface of the tympanic membrane (TM). This occurs particularly with marginal perforations due to squamous migration. Experience with endoscopic removal of EPC associated with perforation is presented.

Study Design: Retrospective chart review.
Setting: Tertiary referral centers.
Patients: Inclusion criteria were patients presenting with a TM perforation and EPC undergoing primary surgery via endoscopic approach. Revision cases were excluded. Patients were referred between 2011 to 2018.
Interventions: Diagnostic and therapeutic.

Main outcome measures: Primary outcomes were rate of residual and recurrent cholesteatoma. Secondary outcomes were change in pure tone average (PTA) pre vs. postoperatively on audiometry and closure of perforation.

Forty-two patients were included (26 male, 16 female) for a total of 42 ears (17 left, 25 right). Average age was 47.2 (range 13-78). Average length of follow up was 19.1 months (range 1-66 months). There were no cases of recurrent cholesteatoma. Two cases (4.8%) of residual cholesteatoma were identified on second-look surgery. Re-perforation occurred in 5 (11.9%) cases. Ossicular chain reconstruction was performed in 8 (19.1%) cases. There was no statistically significant difference between pre- vs. postoperative PTA (30.2dB vs. 29.7dB, p=0.92). Majority of cases were performed entirely via endoscopy, with atticotomy in 10 patients (23.8%) and canalplasty in 2 (4.7%). Only one case required conversion to mastoidectomy. There were no significant intraoperative or postoperative complications.

The data demonstrates that endoscopic management of EPC has excellent control of residual and recurrent disease, with minimal surgical morbidity.