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Our objective was to determine the usefulness of intraoperative rigid endoscopy in detecting incompletely removed cholesteatomas, and to learn whether "second-look" procedures are still needed in children. We used 30 degrees, 2.7-mm endoscopes to evaluate the middle ears of 14 children (29 procedures) with cholesteatomas once all visible disease had been removed under the operating microscope. If residual cholesteatoma was seen, removal continued until all disease visualized with the endoscope was removed. If the cholesteatoma was not removed intact, planned exploratory surgery was performed. The rigid endoscope detected incompletely removed cholesteatomas at surgery in 7 of the 29 cases (24%). In 2 of the 11 cases (18%) judged free of cholesteatoma by both otomicroscopy and otoendoscopy, residual disease was found at planned exploratory procedures. While otoendoscopy is clearly useful in detecting incompletely removed cholesteatoma, a substantial rate of residual disease following "complete" removal suggests the continued need for planned exploratory procedures.

The development of rigid bronchoscopes, Hopkins rod telescopes, and optical forceps has increased the efficacy and safety of removing endobronchial foreign bodies. These instruments have become the method of choice for managing the majority of foreign bodies. Spherical foreign bodies, such as beads, remain difficult to manage. Securing the foreign body by passing a Fogarty catheter through the lumen, inflating the balloon, and trapping the foreign body between the balloon and the bronchoscope allows controlled removal.

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