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.

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.

Academic otology practice.

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.

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.

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.

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.