Transcanal Endoscopic Ear Surgery For Advanced External Acoustic Canal Choleasteatoma In Naim Stage III and IV

By June 7, 2019

Li, Yang1; Wu, Baojun1; Liang, Jianmin1; Ren, Xiaoyong1; Sheng, Ying1
1 Department of Otolaryngology-Head and Neck Surgery, The Second Hospital, Xi’an Jiao Tong University, Xi’an, China.

The purpose of present study was to report tanscanal endoscopic ear surgery (TEES) techniques and treatment outcomes in patients with advanced external auditory canal cholesteatoma (EACC).

-Study Design: Case series
-Setting: University hospital
-Patients: 23 EACC patients in Naim stage Ⅲ /Ⅳ who underwent TEES were enrolled in this study.
-Intervention: All patients underwent a  pre-operative computed tomography of the temporal bones, audiometric assessment. Follow-up  was arranged at 2 weeks after surgery.

-Main outcome measures: The lesion extension, surgical techniques, complications, the air-bone gap (ABG) and the healing time  have been assessed.
-Results: Mastoid involvement represented highest proportion in this study (30%), followed by middle ear (26%), temporal-mandibular joint(TMJ) (17%), antrum (17%), facial nerve (17%). Adequate debridement, endoscopic canaloplasty and M-meatoplasty, typmpanoplasty are the basic techniques for all cases, other such as temporo-mandibular joint revision, ossicular reconstruction and canal wall up technique was based on the extension of EACC. No cases of sensorineural hearing loss or facial paralysis were observed after a mean follow-up of 15 months. 2 patients required revision surgery including one perforation in the central part of the TM and one postoperative EAC stenosis. ABG in postoperative 12 month was 19.5 ±8.3 dB, significantly decreased than preoperative score 32.7 ±8.6 dB (P < 0.05). 96% patients retained a dry and self-cleaning EAC. Primary healing time showed a significant difference between stage III and stage IV cases ( P < 0.05).

TEES provides a minimal invasive treatment for advanced EACC. Some critical oto-endoscopic techniques, such as endoscopic canaloplasty, tympanoplasty, canal wall up technique, ossicular reconstruction , should be mastered before underwenting TEES.