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Recidivism after Endoscopic Treatment of Cholesteatoma – World Congress on Endoscopic Ear Surgery

Recidivism after Endoscopic Treatment of Cholesteatoma

By June 7, 2019

Killeen, Daniel E.1; Tolisano, Anthony M.1; Kou, Yann Fuu1; Kutz, Jr, Joe Walter1; Isaacson, Brandon1
1 Department of Otolaryngology – Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Objective:
To investigate the recidivism rate of cholesteatoma treated via transcanal endoscopic ear surgery (TEES) or endoscopic assisted tympanomastoidectomy compared to a microscopic postauricular approach.

Study Design:
Retrospective chart review.

Setting:
Academic otology practice.

Patients:
Adult patients (18 years and older) with at least 11 months of surgical follow-up who were treated for cholesteatoma via endoscopic techniques or microscopic postauricular approach.

Intervention:
Use of the endoscope for cholesteatoma dissection.

Main outcome measure:
Residual or recurrent cholesteatoma identified at second look surgery or postoperative diffusion-weighted magnetic resonance imaging.

Results:
Fifty-nine patients treated for cholesteatoma via endoscopic techniques and 35 patients treated via microscopic postauricular approach were analyzed. The endoscopic group required significantly fewer mastoid procedures (28% vs. 80%, p-value 0.001). Postoperative changes in median ABG (5 dB vs. 3.75 dB, p=0.9519), median PTA (6.875 dB vs. 1.25 dB, p=0.3864), and median word recognition score (0% vs. 0%, p=0.3302) were not significantly different between the TEES and microscopic surgery groups. Median operative times were not significantly different between the two groups (182 min endoscopic vs. 174 min microscopic, p-value 0.66). The rate of residual disease (17% TEES vs. 17% microscopic, p=0.959) or disease recurrence (18% endoscopic vs. 20% microscopic, p=0.816) were not significantly different between the two groups.

Conclusions:
TEES is an effective alternative to cholesteatoma management, allowing for similar rates of recurrent or residual disease as compared to the more traditional microscopic postauricular approach.