Transcanal Endoscopic Ear Surgery for Attic Cholesteatoma

Min Young Kwak1; Younjoo Choi1; Woo Seok Kang1; Jong Woo Chung1
1 Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.

Objective: To evaluate the efficacy of endoscopic ear surgery for primary acquired attic cholesteatoma.

Participants: Thirty-one patients with attic cholesteatoma were enrolled in this study from Aug 2014 to Aug 2018.

Main outcome measures: We evaluated the extent of cholesteatoma in the endoscopic approaches compared with the preoperative CT findings based on the JOS(Japan Otological Society) staging system. The hearing preservation outcomes, recurrence and complication rates were also analyzed.

Results: We determined the application of endoscopic ear surgery for attic cholesteatoma by preoperative CT findings. Total 31 patients showed the cholesteatoma confined to the attic region with or without involving tympanum and antrum. Twenty patients had the same extent of cholesteatoma as shown in preoperative CT. The extent of cholesteatoma in seven patients showed smaller than preoperative CT findings, and in 4 patients showed severer than preoperative CT findings. We were able to remove the cholesteatoma completely by endoscopic approach alone without any complications in 28 out of 31 patients. Combination of microscopic mastoidectomy was needed to remove cholesteatoma in 3 patients. The mean follow-up period was 13 months. Average thresholds of the preoperative and postoperative air-bone gap were 17.94+-11.12dB and 12.70+-9.75dB respectively. Recurrence cholesteatoma was found in 1 of 31 patients (3%).

Conclusion: Transcanal endoscopic ear surgery is useful in the primary acquired attic cholesteatoma. Temporal bone CT alone cannot provide the extent of cholesteatoma in one-third of the cases. Therefore, more evaluation tool is needed, and microscopic combination surgery is sometimes required.