The main application of endoscopic surgery relies on the middle ear cholesteatoma surgical treatment, although for a definitive validation and acceptance by scientific community, long-term results are needed about recurrent and residual rates of the pathology. The aim of the present paper was to analyze the single institution experience with the long-term results of surgical treatment of attic cholesteatoma.
Key points
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Around the corner spaces can be easily visualized by endoscopic ear surgery.
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The surgical approach should respect as much as possible the physiology and the anatomy of the middle ear.
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Middle ear folds may play an important role in the blockage of ventilation routes, possibly provoking sectorial epitympanic dysventilation.
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Long-term results are crucial to validate a surgical technique to treat cholesteatoma.
Introduction
Surgical treatment of cholesteatoma remains controversial. Endoscopic instrumentation, techniques, and knowledge have improved over the last few years, and we believe that, in the future, endoscopic surgical techniques will gain increasing importance in otologic surgery. From our 9-year experience in endoscopic ear surgery, we believe that most of the spaces considered to be difficult to access with a microscopic technique could be visualized easily by endoscope-assisted surgery, and we believe that new anatomic concepts should be introduced for this. In this perspective, classic concepts of microscopic ear surgery, such as canal wall up and canal wall down tympanoplasties, could be completely modified on clinical and surgical practice.
When a new technique is introduced, it is essential to report results in the literature so the technique can be reviewed and hopefully accepted by scientific community. Because endoscopic ear surgery is a relatively new technique, few papers are present in the literature to report results. The aim of present paper is to report the results at our institution (Modena University Hospitals) regarding endoscopic treatment of cholesteatoma at a mean follow-up of 5 years, so add to the experience reported previously on this topic.
Introduction
Surgical treatment of cholesteatoma remains controversial. Endoscopic instrumentation, techniques, and knowledge have improved over the last few years, and we believe that, in the future, endoscopic surgical techniques will gain increasing importance in otologic surgery. From our 9-year experience in endoscopic ear surgery, we believe that most of the spaces considered to be difficult to access with a microscopic technique could be visualized easily by endoscope-assisted surgery, and we believe that new anatomic concepts should be introduced for this. In this perspective, classic concepts of microscopic ear surgery, such as canal wall up and canal wall down tympanoplasties, could be completely modified on clinical and surgical practice.
When a new technique is introduced, it is essential to report results in the literature so the technique can be reviewed and hopefully accepted by scientific community. Because endoscopic ear surgery is a relatively new technique, few papers are present in the literature to report results. The aim of present paper is to report the results at our institution (Modena University Hospitals) regarding endoscopic treatment of cholesteatoma at a mean follow-up of 5 years, so add to the experience reported previously on this topic.
Material and methods
Starting in January 2006, we created a database in which all patients who underwent operation for middle ear indication and were followed in our clinic by regular visits at appropriate timing (in general after 1, 3, 6, and 12 months form the operation, then yearly) were included. At follow-up, patients were evaluated by an endoscopic office examination. Recurrences (defined as non–self-cleaning re-retraction of the attic requiring surgery) and residual (defined as insufficient primary resection of the epidermal matrix, presenting as cholesteatoma in absence of re-retraction of the tympanic membrane) were noted in the database. Residuals were defined by evaluations using computed tomography, performed most often at 1 year of follow-up or during a planned surgical second look. During September 2015, we reviewed the database to obtain results, and an analyses of 300 endoscopic or combined (endoscopic/microscopic) procedures to middle ear chronic otitis was performed. For the present study, only cholesteatomas treated endoscopically (exclusively or combined) with at least 3 years of follow-up were included for further analyses; canal wall down procedures were excluded.
Results
The final study group included 244 ears (of 234 patients). The mean follow-up was 64.3 months (standard deviation 22.2). There were patients 166 (68%) free from disease during postoperative follow-up visit, 29 patients (12%) were diagnosed a recurrence, and 49 patients (20%) had residual disease ( Fig. 1 ). Patients with recurrence and residual disease underwent second stage surgery and, in the final follow-up visit, another 50 patients (20.5%) were free from disease. There were 144 patients (69.5%) who underwent an exclusive endoscopic approach, whereas 100 patients (30.5%) underwent a combined approach with mastoidectomy ( Fig. 2 ). Seventy-three patients (30%) had a cholesteatoma limited exclusively to the attic, whereas 44 (18%) had also a mesotympanic extension of the disease, 37 (15%) patients had an exclusive involvement of the mesotympanum, 73 (30%) had antral extension, and 17 (7%) had mastoid extension. There were 41 patients (17%) who were aged under 18 years, and 203 (83%) were adults.
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