Endaural microscopic approach versus endoscopic transcanal approach in treatment of attic cholesteatomas

Iannella, Giannicola; Pace, Annalisa; Greco, Antonio; Polimeni, Antonella; Maniaci, Antonino; Mucchino, Alessandro; Lechien, Jérôme R.; Saibene, Alberto Maria; Mat, Quentin; Gargula, Stéphane; Fakhry, Nicolas; Simone, François; Gioacchini, Federico Maria; Re, Massimo; Magliulo, Giuseppe

doi:10.1016/j.amjoto.2023.103860

Cited by 5 publications

(1 citation statement)

References 23 publications

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“…Different surgical techniques to remove cholesteatomas in children and adults are still being discussed in the recent literature, even after endoscopic assistance was added to the surgical armamentarium [ 3 , 6 , 17 , 18 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

The Role of Endoscopic Assistance in Surgery for Pediatric Cholesteatoma in Reducing Residual and Recurrent Disease

Nassif,

Redaelli de Zinis

2024

Children

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The primary aim of this study was to evaluate long-term recurrent and residual disease after surgery for acquired cholesteatoma in children according to surgical approach. A total of 71 interventions performed on 67 pediatric patients were included in the study. Canal wall-up tympanomastoidectomy (CWUT) was performed in 31 ears (13 with endoscopic assistance), a transcanal esclusive endoscopic approach (TEEA) was used in 22, and canal wall-down tympanomastoidectomy (CWDT) was performed in 18. Overall, the cholesteatoma relapse rate estimated by the Kaplan–Meier method was 47 ± 6% at 12 years; the recurrent cholesteatoma rate was 28 ± 6% and the residual cholesteatoma rate was 26 ± 5%. The relapse rate according to surgical approach was 33 ± 11% for CWDT, 60 ± 9% for CWUT, and 40 ± 11% for TEEA (p = 0.04). The difference for recurrent disease was no recurrent disease for CWDT, 42 ± 9% for CWUT, and 32 ± 11% for TEEA (p = 0.01). The residual disease rate was significantly reduced with endoscopy: 42 ± 8% without endoscopy vs. 9 ± 5% with (p = 0.003). CWDT can still be considered in primary surgery in case of extensive cholesteatomas and small mastoid with poor pneumatization. TEEA can be recommended for small cholesteatoma not extending to the mastoid to reduce morbidity. Endoscopic assistance seems useful to reduce residual disease in CWUT, whereas it does not have a significant impact on preventing recurrent disease.

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Section: Discussionmentioning

confidence: 99%

The Role of Endoscopic Assistance in Surgery for Pediatric Cholesteatoma in Reducing Residual and Recurrent Disease

Nassif,

Redaelli de Zinis

2024

Children

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Endoscopic ear surgery in the treatment of chronic otitis media with atelectasis

Iannella,

Pace,

Greco

et al. 2024

Eur Arch Otorhinolaryngol

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Purpose Atelectasis otitis media (AtOM) is a chronic condition where the tympanic membrane (TM) becomes retracted towards the middle ear and the ossicular chain. Surgical treatment for this condition could be indicated based on stage of atelectasis, patient’s clinical condition and hearing loss. Over the years, AtOM has been treated with various types of tympanoplasty under microscopic view. The aim of this study is to present the results of endoscopic ear surgery in AtOM. Methods Forty-five patients who underwent endoscopic trans-canal tympanoplasty were included in the study. Preoperative features, intraoperative findings and postoperative outcomes were collected. Results Preoperatively, none of the study's patients were classified with a Sadè Grade I, whereas grades II, III and IV were 3 (6.6%), 23 (32.1%) and 19 (67.8%) respectively. The 3 patients with Sadè grade II showed a conductive hearing loss higher than 20 dB and a continuous ear fullness, therefore they were surgically treated. The postoperative graft success rate was estimated at 95.5%. During follow-up, 2 patients showed a TM perforation (at 6 and 12 months after surgery) whereas 1 patient experienced a recurrence of atelectasis in the TM (16 months after surgery). The overall success rate at the final follow-up was calculated at 88.8%. The average preoperative air-conduction threshold was 51.1 ± 21.5, which reduced to 34.6 ± 22.1 (p = 0.04) at follow-up. The preoperative air–bone gap decreased from 28 ± 7.2 to 11.8 ± 10 (p = 0.002) after surgery. Conclusion Atelectasis otitis media might be suitable for exclusive endoscopic surgical treatment, as it appears to exhibit a low recurrence rate and promising audiological outcomes.

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Health-related quality of life in patients after endoscopic or microscopic cholesteatoma surgery

Raemy,

Bächinger,

Peter

et al. 2024

Eur Arch Otorhinolaryngol

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Purpose Different surgical techniques exist for treating cholesteatoma, such as microscopical or transcanal endoscopic ear surgery (TEES). This study aimed to compare these two techniques, focusing on quality of life. Methods This retrospective single-center study included 188 patients with cholesteatoma. The primary outcome was the assessment of health-related quality of life (HRQoL) using the Zurich Chronic Middle Ear Inventory (ZCMEI-21) preoperatively, 3 and 12 months postoperatively with regard to surgical technique and intraoperative staging of the cholesteatoma (ChOLE classification). Secondary outcomes included hearing pure tone average of 0.5, 1, 2 and 4 kHz (PTA4), complications assessed 3 months postoperatively as well as recidivism within the follow-up time of 1 year postoperatively. Results A total of 28 patients underwent TEES and 160 microscopic ear surgery. The ZCMEI-21 total scores preoperatively were not significantly different between the two groups. An improvement in QoL one year postoperatively was observed in both groups to a comparable extent. The ZCMEI-21 decreased significantly (p < 0.01) in both groups. In the TEES group, the cholesteatoma tended to be smaller (lower ChOLE score), PTA4 was better and complication rate comparable. The number of recidivisms was lower for the TEES group (1 [3.6%] vs. 31 [19.4%]). Conclusion TEES is a valuable alternative to the traditional microscopic technique, at least for small cholesteatoma, which leads to a comparable improvement in HRQoL as the microscopic technique. The better postoperative hearing and lower rate of recidivism in the TEES group may be related to the smaller extent of the cholesteatoma.

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Endaural microscopic approach versus endoscopic transcanal approach in treatment of attic cholesteatomas

Cited by 5 publications

References 23 publications

The Role of Endoscopic Assistance in Surgery for Pediatric Cholesteatoma in Reducing Residual and Recurrent Disease

The Role of Endoscopic Assistance in Surgery for Pediatric Cholesteatoma in Reducing Residual and Recurrent Disease

Endoscopic ear surgery in the treatment of chronic otitis media with atelectasis

Health-related quality of life in patients after endoscopic or microscopic cholesteatoma surgery

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