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.
Introduction:
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).
Methods:
-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.
Discussion:
-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).
Conclusions:
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.