Korean J Otorhinolaryngol-Head Neck Surg.  2017 Apr;60(4):158-163. 10.3342/kjorl-hns.2016.17027.

Minimally Invasive Transcanal Removal of Attic Cholesteatoma

• Choi JE
• Kim HJ
• Kim BK
• Moon IJ

• KMID: 2377569
• DOI: http://doi.org/10.3342/kjorl-hns.2016.17027

Abstract

BACKGROUND AND OBJECTIVES
In treating attic cholesteatoma, traditional microscopic approach provides limited exposure to the attic space. Recently, the use of endoscope has emerged as a new treatment option for attic cholesteatoma. The aim of this study is to report the preliminary results of transcanal endoscopic removal of attic cholesteatoma and to evaluate the feasibility of endoscopic approach to attic cholesteatoma.
SUBJECTS AND METHOD
Six patients with attic cholesteatoma were enrolled in this study from Sep 2014 to Oct 2015. Cholesteatoma was removed via transcanal endoscopic approach. We analyzed the clinical characteristics, surgical management and treatment outcomes.
RESULTS
All patients had attic cholesteatoma in the epitympanic space with scutum erosion. However, the disease was restricted to the epitympanic space in three patients, whereas a limited extension of cholesteatoma to the aditus ad antrum was observed in two patients, and mesotympanum was involved in the remaining one patient. All of the patients suffered from conductive or mixed hearing loss with mean air-bone gap of 17.4 dB, and underwent endoscopic transcanal removal of cholesteatoma and scutoplasty. In three patients, the incus and malleus head were removed due to ossicular erosion, and a second-stage ossicular reconstruction was planned. No residual or recurrent diseases were noted during the follow-up period (mean: 13 months). No surgical complications were observed postoperatively, and favorable hearing outcome was obtained in all patients.
CONCLUSION
Transcanal endoscopic approach was successfully performed in patients with limited attic cholesteatoma. Further studies involving a large number of patients with long-term follow-ups are necessary to prove the clinical efficacy of transcanal endoscopic approach in managing limited attic cholesteatoma.

Keyword

Attic cholesteatoma; Endoscope; Minimally invasive surgery; Transcanal endoscopic ear surgery

MeSH Terms

Cholesteatoma*
Endoscopes
Follow-Up Studies
Head
Hearing
Hearing Loss, Mixed Conductive-Sensorineural
Humans
Incus
Malleus
Methods
Minimally Invasive Surgical Procedures
Treatment Outcome