Endoscopic Ear Surgery (EES) for Congenital Cholesteatoma in Children

Yeonjoo Choi; Min young Kwak; Woo Seok Kang; Jong Woo Chung
Department of Otorhinolaryngology-Head and Neck Surgery,  University of Ulsan, College of Medicine, Asian Medical Center, Seoul, South Korea

Introduction: Endoscopic approach for ear surgery has become one of the most promising techniques for removing congenital cholesteatoma (CC). The aim of this study is to describe our experience in managing CC with endoscopic approach, and compare with conventional microscopic approach.

Study design: Retrospective review.
Setting: Tertiary referral center.
Patients: 36 patients diagnosed with CC from Jan. 2013 to Dec. 2018.
Intervention: 13 patients underwent microscopic approach surgery (non-EES group) and 23 patients underwent endoscopic approach surgery (EES group).

Results: There were no difference in the baseline parameter between two groups; age (p=0.113), gender (p=0.259), eroded ossicles status (p=1.00), cholesteatoma size (p=0.099), site (p=0.923), type(closed or open) (p=0.075) and Postic’s stage (p=0.712). There were no significantly difference in operation time between two groups; 1.31 hours for non-EES group, 1.69 hours for EES group (p=0.186). No residual CC and postoperative sensorineural hearing loss were reported in both groups. No significant differences were shown between two groups regarding postoperative complications and recurrence (p=0.328, p=0.609). No audiologic differences were reported between two groups by comparing preoperative and postoperative pure tone audiometry; 1.25dB and 1.59dB were improved after surgery, respectively regardless of ossiculoplasty (p=0.925). There were significantly shorter hospital days in EES group(2.39 days) than non-EES group(3.15 days) (p=0.006).
Conclusion: EES is not inferior to conventional microscopic approach, even it representes superiority in terms of postoperative recovery. Endoscopic approach for removing CC is feasible and valuable methods allowing good surgical control of cholesteatoma in hidden area especially in young patients.

Discussion: Main outcome measures: Operation time, hospital stay, postoperative complication, and recurrence.