Endoscopic Ear Surgery
Management of 242 patients with middle ear cholesteatoma by otoendoscopic surgery and the postoperative effect analysis
Wu Nan, Wang Zhaoyan, Yu Youjun, Zhang Wen, Yang Qiong, Chen Suijun, Hou Zhaohui
Published 2019-04-07
Cite as Chin J Otorhinolaryngol Head Neck Surg, 2019, 54(4): 251-256. DOI: 10.3760/cma.j.issn.1673-0860.2019.04.003
Abstract
ObjectiveTo summarize and discuss the characteristics of endoscopic approach to manage the middle ear cholesteatoma, and to evaluate the operative safety and outcomes based on the data from the multicenter study.
MethodsThe data of 242 cases diagnosed with the middle ear cholesteatoma and received operation through endoscopic approach between June 2016 and June 2017 in six tertiary hospitals in China were analyzed in this work. There were 130 males and 112 females, with the age ranging from 3 to 72 years old. We evaluated the strategy about how to manage the cholesteatoma, discussed the detailed techniques about how to remove the cholesteatoma and to improve the efficiency under endoscopic visualization. Meanwhile, the recurrence rate and residual rate of cholesteatoma as well as the complications in endoscopic approach were summarized.
ResultsA total of 158 cases were operated in exclusively endoscopic transcanal approach, 72 cases operated in combined approach, and 12 cases operated majorly under microscope and minorly under endoscope. 219 cases were operated in one stage surgery, 23 cases received second look. In the second look, 3 cases were detected with residual cholesteatomas. Among them, 2 cases were found by MRI-DWI examination after the first-stage operation. With endoscopic examination after operation, 17 cases showed retracted pocket recurrence (7%,17/242). With introduction of endoscope in cholesteatoma, 153 cases were achieved canal wall-up operation (63%, 153/242). The complications in endoscopic approach included chord tympani never injury in 27 cases, skin injury of ear canal in 11 cases, tinnitus in 13 cases, vertigo in 7 cases, external ear canal stenosis in 1 case.
ConclusionsUsing otoendoscope in cholesteatoma surgery would help keeping the normal structures of middle ear as much as possible, benefit to remove the hiding pathologies, help reducing residual cholesteatoma and lowering the rate of canal wall-down operation as well. This study showed good safety of otoendoscopic cholesteatoma surgery, however, strict evaluation of indication and quite good surgical techniques and skills are necessary for avoiding unexpected complication.
Key words:
Endoscopic ear surgery; Cholesteatoma, middle ear; Recurrence; Residual
Contributor Information
Wu Nan
Department of Otorhinolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing 100853, China
Wang Zhaoyan
Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Ninth People′s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
Yu Youjun
Department of Otorhinolaryngology Head and Neck Surgery, First People′s Hospital of Foshan, Foshan 528000, China
Zhang Wen
Department of Otorhinolaryngology Head and Neck Surgery, Shaanxi Provincial People′s Hospital, Xi′an 710068, China
Yang Qiong
Department of Otorhinolaryngology Head and Neck Surgery, Shenzhen Sixth People′s Hospital (Nanshan Hospital), Shen Zhen 518052, China
Chen Suijun
Department of Otorhinolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
Hou Zhaohui
Department of Otorhinolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing 100853, China
