From the Guidelines
Endoscopic ear surgery is a highly effective and recommended approach for treating congenital cholesteatoma, offering superior visualization and minimal invasiveness compared to traditional methods. This technique utilizes small endoscopes inserted through the ear canal to provide detailed views of middle ear structures, allowing for precise removal of the cholesteatoma while preserving surrounding tissues. The procedure typically involves a transcanal approach, where a tympanomeatal flap is created to access the middle ear, and the cholesteatoma is then carefully removed.
Key Benefits and Considerations
- Better visualization of hidden areas, such as the facial recess and sinus tympani, due to the angled vision provided by the endoscopes 1
- Reduced need for bone removal, leading to less trauma to the ear and faster recovery times
- Improved cosmetic outcomes, as no external incisions are required
- Requires specialized training and single-handed surgical technique, which may be challenging for very extensive disease
- Postoperative care includes antibiotic ear drops and pain management, with follow-up appointments to monitor healing and check for recurrence, which occurs in approximately 5-20% of cases 1
Procedure and Recovery
The procedure typically takes 1-3 hours under general anesthesia, with most patients discharged the same day or after overnight observation.
- Postoperative care: antibiotic ear drops (such as ciprofloxacin/dexamethasone) for 7-10 days, pain management with acetaminophen or ibuprofen
- Follow-up appointments: 1-2 weeks, 6 weeks, and 6 months to monitor healing and check for recurrence It is essential to note that while the provided evidence primarily discusses congenital choanal atresia, the principles of endoscopic surgery and its benefits can be applied to the treatment of congenital cholesteatoma, emphasizing the importance of specialized training and careful patient selection.
From the Research
Overview of Endoscopic Ear Surgery for Congenital Cholesteatoma
- Endoscopic ear surgery has become increasingly popular due to improved instrumentation, techniques, and knowledge 2.
- Transcanal endoscopic ear surgery (TEES) provides better visualization of hidden areas in the middle ear cavity during congenital cholesteatoma removal 2, 3.
- The endoscopic approach allows for complete removal of cholesteatoma via a minimally invasive technique, offering low residual disease rates while preserving the normal physiology of the middle ear and possibly the ossicular chain 4.
Surgical Outcomes and Complications
- Congenital cholesteatoma can be removed successfully via a transcanal endoscopic approach in all patients, with no surgical complications occurring in some studies 2.
- Recurrence of congenital cholesteatoma was observed in a few cases, with some patients undergoing revision surgery 2, 3, 5.
- Postoperative complications, such as tympanic membrane perforation and retraction, were observed in some cases 3, 5.
Comparison with Conventional Microscopic Approaches
- Endoscopic ear surgery is not inferior to conventional microscopic approaches in terms of operative time, hospital stay, postoperative complications, and recurrence/residue of congenital cholesteatoma 3.
- The endoscopic approach provides greater visual access to hidden areas of the middle ear and facilitates middle-ear manipulation 3.
Special Considerations
- In cases of bilateral congenital cholesteatoma, hearing preservation is more crucial than in unilateral cases, and the endoscopic approach can help preserve the normal physiology of the middle ear and possibly the ossicular chain 4.
- The endoscopic approach can be useful in removing congenital cholesteatoma in hidden areas within the middle ear, such as the anterior epitympanic recess 6.