Clin Exp Otorhinolaryngol.  2018 Dec;11(4):233-241. 10.21053/ceo.2018.00122.

Transcanal Endoscopic Ear Surgery for Congenital Cholesteatoma

• Park JH
• Ahn J
• Moon IJ

• KMID: 2439849
• DOI: http://doi.org/10.21053/ceo.2018.00122

Abstract

OBJECTIVES
As endoscopic instrumentation, techniques and knowledges have significantly improved recently, endoscopic ear surgery has become increasingly popular. Transcanal endoscopic ear surgery (TEES) can provide better visualization of hidden areas in the middle ear cavity during congenital cholesteatoma removal. We aimed to describe outcomes for TEES for congenital cholesteatoma in a pediatric population.
METHODS
Twenty-five children (age, 17 months to 9 years) with congenital cholesteatoma confined to the middle ear underwent TEES by an experienced surgeon; 13 children had been classified as Potsic stage I, seven as stage II, and five as stage III. The mean follow-up period was 24 months. Recurrence of congenital cholesteatoma and surgical complication was observed.
RESULTS
Congenital cholesteatoma can be removed successfully via transcanal endoscopic approach in all patients, and no surgical complications occurred; only one patient with a stage II cholesteatoma showed recurrence during the follow-up visit, and the patient underwent revision surgery. The other patients underwent one-stage operations and showed no cholesteatoma recurrence at their last visits. Two patients underwent second-stage ossicular reconstruction.
CONCLUSION
Although the follow-up period and number of patients were limited, pediatric congenital cholesteatoma limited to the middle ear cavity could be safely and effectively removed using TEES.

Keyword

Congenital Cholesteatoma; Endoscopy; Minimally Invasive Surgical Procedures

MeSH Terms

Child
Cholesteatoma*
Ear*
Ear, Middle
Endoscopy
Follow-Up Studies
Humans
Minimally Invasive Surgical Procedures
Recurrence

Figure

• 

  Fig. 1. Preoperative and operative findings in case 18. (A) Endoscopic findings revealed a white round mass behind the anterior superior quadrant of the tympanic membrane. (B) Computed tomography showed a well-defined round mass of soft tissue density at the anterior aspect of the malleus handle (arrow). A closed-type cholesteatoma (arrowhead) was recognized after a tympanomeatal flap was elevated (C) and removed completely (D, E). (F) The absence of congenital cholesteatoma was confirmed in the tympanic cavity including the cochleariform process (asterisk).

• 

  Fig. 2. Preoperative findings in case 13. (A) Endoscopic findings revealed a white round mass behind the inferior half of the intact tympanic membrane. (B) Pure tone audiometry revealed conductive hearing loss of 25 dB air-bone gap in the right ear (red lines), while left hearing was normal (blue line). (C, D) Preoperative computed tomography scans demonstrated a mass of soft tissue density occupying the mesotympanum and extending sinus tympani with ossicular destruction.

• 

  Fig. 3. Operative findings in case 13. (A) Endoscopic findings revealed a large white mass occupying the tympanum behind the tympanomeatal flap. (B) The cholesteatoma was too large to remove en bloc, so it was opened and reduced in size by removing inner keratin debris. The cholesteatoma was carefully dissected from the surrounding structure while the surgeon was careful not to lose hold of the sac (arrow). The anterior part of the cholesteatoma was carefully dissected from the surrounding structure (C) and completely removed including in the posterior tympanum (arrows; D, E). (F) The absence of congenital cholesteatoma (CC) was confirmed in the tympanic cavity. CT, chorda tympani; Mh, malleus handle; S, stapes; RW, round window niche.

• 

  Fig. 4. Postoperative findings in case 13. An endoscopic exam (A) and computed tomography scans (B, C, axial and coronal) showed no residual or recurrent cholesteatoma at 10-month follow-up. Air-bone gap in the right ear (red lines; left ear, blue line) (D) after the first operation, in which the destructed incus was removed with the congenital cholesteatoma, decreased substantially (E) after the second stage ossiculoplasty performed 1 year after congenital cholesteatoma removal.

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