Effect of Endoscope-Assistance in Mastoidectomy For Lowering the Rate of Residual Cholesteatoma Results From 91 Pediatric Patients

Ohad Hilly, MD1,2*, Dan Yaniv, MD1,2; Sharon Tzelnick, MD1,2; David Ulanovski, MD1,3; Eyal Raveh, MD1,3*
1 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
2 Department of Otorhinolaryngology‑Head and Neck Surgery, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
3 Pediatric Otolaryngology Unit, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel

Introduction: Canal wall up (CWU) mastoidectomy is commonly performed in cases of chronic otitis media with cholesteatoma. The use of endoscopes during this surgery is increasing in order to improve visualization of difficult access sites.
We aim to determine the efficacy of adding endoscopy to traditional microscopic mastoidectomy in reducing the rate of residual cholesteatoma in children.

Design: Retrospective cohort.
Setting: Tertiary university-affiliated pediatric medical center.
Patients: Patients undergoing primary surgery for cholesteatoma in 2009-2016 by a microscopy-only or endoscopy-assisted approach.
Intervention: Tympanomastoidectomty with or without use of endoscope

Main outcome measures:  Rate and location of recurrences.

Results: The cohort included 91 patients who underwent CWU surgery for primary cholesteatoma. Intraoperative endoscopic evaluation was performed in 49 cases (53.8%). Overall, 43 (47.2%) patients needed revision surgery due to residual or recurrent disease. The rate of revision surgery was lower in the endoscopy-assisted group (44.8%) than in the microscope-only group (59.5%), but the difference did not reach statistical significance (p=0.1). Limiting the analysis to cases of residual disease (intact tympanic membrane at diagnosis) revealed that intraoperative endoscopic significantly lowered the rate of residual cholesteatoma to 18.36 compared to 38.09% in the microscopy-only group (p=0.036).

Conclusion: The study showed that the use of an endoscope during mastoidectomy in addition to the operating microscope reduced residual disease rates. Endoscopy may serve as an important adjunct in pediatric cholesteatoma surgery.