Endoscopic Transcanal Modified Canal Wall Down Mastoidectomy for Cholesteatoma in Sclerotic Mastoids

By June 6, 2019

Sajjadi, Hamed1
1 Stanford University Department of Otolaryngology-Head & Neck surgery

Attic and antrum Cholesteatoma in a tight sclerotic mastoid cavity is a very difficult disease to eradicate. The well-established “inside-out” attico-antrotomy resection is hereby performed completely transcanal using with one-handed drilling using ear endoscopes and high definition rigid video. The canal wall defect is repaired with cartilage to recreate an intact canal wall down result. The exact details on how to do this technique are described step by step.


  • Study design: retrospective case review
  • setting: Tertiary referral center
  • patients: 4 patients operated between 2013-2017
  • Intervention (s): endoscopic transcanal tympanomastoidectomy

Main Outcome Measure(s): Cholesteatoma resection, disease recurrence

Two patients opted for second look endoscopic approach, one had residual Cholesteatoma. Two other patients underwent special MRI protocol and both have shown negative serial MRIs at 2 years post op with clinically stable ears.

Endoscopic transcanal modified canal wall down Mastoidectomy for resection of antral Cholesteatoma in sclerotic small mastoids is feasible and safe. Technique requires advanced endoscopic skills. Postoperative pain seems to be negligible and recovery is fast with no mastoid dressing, and no external incisions or sutures.

Since this technique is in essence a “closed cavity” approach, the rules of Cholesteatoma surveillance in a closed cavity approach should apply here as well, meaning the surgeon needs to either perform a scheduled “second-look” surgery or do serial special MRI follow up protocol.