Hearing and ossicular chain preservation in cholesteatoma surgery

Patency of Anterior Epitympanic Space and Surgical Outcomes After Endoscopic Ear Surgery for the Attic Cholesteatoma

OBJECTIVE

To reveal the patency of the anterior epitympanic space (AES) and the surgical outcomes after transcanal endoscopic ear surgery (TEES) for attic cholesteatoma with a classification of anatomical variation of the AES.

STUDY DESIGN

Retrospective case review.

SETTING

Tertiary referral center.

PATIENTS

Seventy-four ears (72 patients with early-stage (I or II) attic cholesteatoma) aged between 16 and 85 years (mean: 48.9 yr) who underwent TEES between 2015 and 2017 were analyzed.

INTERVENTION

Tympanoplasty with atticoantrotomy was performed with TEES. TEES was performed using a rigid endoscope with an outer diameter of 2.7 mm.

MAIN OUTCOME MEASURE

The tensor fold in the AES anatomical classification, the postoperative patency of the AES evaluated by computer tomography images, and hearing outcomes based on the American Academy of Otolaryngology and Head and Neck Surgery criteria were evaluated after TEES for early-stage attic cholesteatoma.

RESULTS

There were 14 (18.9%) ears with a vertical tensor fold orientation, 29 (39.2%) ears with an oblique orientation, and 29 (39.2%) ears with a horizontal orientation. The total postoperative patency rate in the AES was 81.0%, without any significant difference in the anatomical variation in the AES, whereas the rate of preoperative complete tensor fold was 90.5%. Cholesteatoma recurrence was observed in three cases (4.1%), and all recurrent cases had obstructed AES. No significant difference was found in the postoperative air-bone gap regardless of the patency of the AES.

CONCLUSION

Our findings indicate that TEES is useful in restoring ventilation in the AES, resulting in favorable management of cholesteatoma.

Cholesteatoma surgery with the canal wall up technique combined with mastoid obliteration: results from primary surgery in 230 consecutive cases

OBJECTIVE

To evaluate the canal wall up (CWU) technique combined with mastoid obliteration used in cholesteatoma surgery from the aspects of safety and function.

STUDY DESIGN

Retrospective chart review. Information was extracted from a medical database and complementary data from patient files and audiograms were collected and recorded retrospectively.

SETTING

A tertiary-stage hospital and a secondary-stage hospital. Surgeons of various levels of experience.

METHOD

Data from a consecutive group of 230 primary operations for cholesteatoma surgery using CWU with obliteration employing the combined approach tympanoplasty (CAT) technique, from January 1994 to December 2009 were analyzed.

RESULTS

In 90% of the ears, the anatomy was normalized with an intact ear drum. The frequency of residual cholesteatoma was 1% and the frequency of recurrent cholesteatoma 8%. Hearing was improved one year postoperatively and remained improved three years postoperatively. No patient suffered a total hearing loss.

CONCLUSIONS

CWU procedure comprising CAT with obliteration of the mastoid is a safe surgical method with a low frequency of residual and recurrent disease and a good hearing preservation.