Endoscopic open technique in patients with middle ear cholesteatoma

Marchioni, Daniele; Villari, Domenico; Alicandri‐Ciufelli, Matteo; Piccinini, Alessia; Presutti, Livio

doi:10.1007/s00405-011-1533-y

Cited by 57 publications

(39 citation statements)

References 10 publications

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“…Since the endoscopic technique was introduced for middle ear surgery, the concept of minimally invasive surgery has developed. This could avoid mastoidectomies, external incisions, and soft tissue dissection in selected cases as compared with the conventional microscopic approach [9,14].…”

Section: Discussionmentioning

confidence: 99%

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Minimally Invasive Transcanal Removal of Attic Cholesteatoma

Choi¹,

Kim²,

Kim³

et al. 2017

Korean J Otorhinolaryngol-Head Neck Surg

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Objectives. This study aimed to compare the outcome of endoscopic and microscopic tympanoplasty.Methods. This was a retrospective comparative study of 73 patients (35 males and 38 females) who underwent type I tympanoplasty at Samsung Medical Center from April to December 2014. The subjects were classified into two groups; endoscopic tympanoplasty (ET, n=25), microscopic tympanoplasty (MT, n=48). Demographic data, perforation size of tympanic membrane at preoperative state, pure tone audiometric results preoperatively and 3 months postoperatively, operation time, sequential postoperative pain scale (NRS-11), and graft success rate were evaluated.Results. The perforation size of the tympanic membrane in ET and MT group was 25.3%±11.7% and 20.1%±11.9%, respectively (P =0.074). Mean operation time of MT (88.9±28.5 minutes) was longer than that of the ET (68.2±22.1 minutes) with a statistical significance (P =0.002). External auditory canal (EAC) width was shorter in the ET group than in the MT group (P =0.011). However, EAC widening was not necessary in the ET group and was performed in 33.3% of patients in the MT group. Graft success rate in the ET and MT group were 100% and 95.8%, respectively; the values were not significantly different (P =0.304). Pre-and postoperative audiometric results including bone and air conduction thresholds and air-bone gap were not significantly different between the groups. In all groups, the postoperative air-bone gap was significantly improved compared to the preoperative air-bone gap. Immediate postoperative pain was similar between the groups. However, pain of 1 day after surgery was significantly less in the ET group. Conclusion.With endoscopic system, minimal invasive tympanoplasty can be possible with similar graft success rate and less pain.

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Section: Discussionmentioning

confidence: 99%

“…The value of endoscopes combined with the conventional microscopic eradication of cholesteatoma has been well established [6][7][8][9][10][11][12][13][14][15]. Besides surgeries for cholesteatoma removal, an exclusively endoscopic approach during tympanoplasty has been applied to facilitate minimally invasive surgery [16,17].…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Transcanal Removal of Attic Cholesteatoma

Choi¹,

Kim²,

Kim³

et al. 2017

Korean J Otorhinolaryngol-Head Neck Surg

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“…Here, all cases could be performed transcanal, avoiding unnecessary post-aural incision and suture clearly favouring better cosmesis and less morbidity. [12,14] Documentation and demonstration of the procedure was simpler which immensely benefits teaching. In endoscopic procedures, all the structures are seen in the same field and hence much easier to appreciate the anatomical relationship between them.…”

Section: Discussionmentioning

confidence: 99%

“…Even slightest of movement of the head of the patient would result in secondary direct trauma to the canal by the tip of the endoscope; co-operation of the patient or quality of the image would be adversely affected. [10,13,14] Premedication and infiltration anaesthesia had hence to be spot on. However, one silver lining here with the use of the larger 4-mm nasal endoscope over the smaller tympanoscope is that since 'off line of sight' visualisation is possible due to its wide viewing angle, direct injury thus to middle ear structures and ossicles were virtually nil since it is almost impossible to smoothly advance the scope even beyond the canal isthmus, let aside the tympanic ring!…”

Section: Discussionmentioning

confidence: 99%

NASAL ENDOSCOPE FOR TYPE 1 TYMPANOPLASTY; PROS & CONS - AN ANALYTICAL STUDY

George¹

2017

jemds

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BACKGROUNDMinimally invasive ear surgery has developed along with endoscopic techniques; this avoids other unnecessary incisions and soft tissue dissections. The endoscopic approach also provides better visualisation of hidden areas in the middle ear cavity and provides better visualisation of structures parallel to the axis and beyond the shaft of the instruments that otherwise can cramp surgery using a microscope. One major disadvantage of using a smaller-diameter endoscope in the ear is a narrow and tubular viewing. The use of a traditional 4 mm, 18 cm nasal endoscope could effectively negate this major disadvantage by providing a close-up wide-angled vision. MATERIALS AND METHODSThis was a prospective 4-year study of endoscopic type 1 tympanoplasty, using 4-mm 0 0 nasal endoscope, in 35 patients with chronic otitis media (COM), having inactive mucosal disease. Per-operative parameters and post-operative results were analysed by standard proforma. RESULTSThere was satisfactory graft uptake in 83.86% (n=29) cases with good air-bone gap closure. 17.14% (n=6) of patients complained of thermal irritation in the ear during surgery. Post-operative infection rate was on the higher side (22.86%). Operating time was comparable to microscopic tympanoplasty. CONCLUSIONThe nasal endoscope provides unmatched middle ear visualisation and image quality with significant benefits in teaching with comparable results to microscopic tympanoplasty. Light source should be used in lower setting to prevent thermal irritation to the ear. Meticulous sterilisation of the endoscope is prudent to prevent post-operative infection.

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“…The endoscopic approach has led to better surgical treatment options for middle ear pathologies by affording round-the-corner views of hidden areas such as sinus tympani, facial recess, anterior epitympanic spaces, attic, hypotympanum and protympanum [8][9][10].…”

Section: Discussionmentioning

confidence: 99%

Use of endoscope as adjunct to microscope in cholesteatoma surgery- A non-randomized, non-controlled study

Verm¹,

Dabholkar²,

Velankar³

et al. 2017

Otorhinolaryngol Head Neck Sur

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Importance; The use of endoscope for the ear has opened up new approaches to treat cholesteatoma surgically and reduce residuals. The endoscope can be used as an adjunct to the microscope or by itself. Aims and objectives:1. To evaluate the use of endoscopy in identifying the cholesteatoma remnant at the time of primary surgery with the operating microscope.2. To evaluate the effectiveness of endoscopy in assessing limited disease during cholesteatoma surgery.Design: A hospital-based, interventional, non-randomized, non-comparative and prospective study was done in 116 ears with acquired cholesteatoma. At the time of the surgery, the endoscope was used to study and identify the extent of the disease. After completion of the surgery by the standard inside-out technique using microscope and drill, the endoscope was used to identify the cholesteatoma remnants if any.Setting: This study was done in a tertiary care hospital.Participants: 116 patients with acquired cholesteatoma that were operated on. Main outcome measure:The proportion of residual disease identified with the help of endoscope at the end of standard surgery using microscope and drill. Secondary outcome measure was the proportion of cases in which endoscope was useful in decision making intra-operatively. Results:Out of 116 patients operated with the microscope, 13 had a cholesteatoma remnant at the end of surgery which was missed by the microscope but identified with the oto-endoscope. The sinus tympani was the commonest site of cholesteatoma remnant. Also in 7 cases, the endoscope helped in limiting the dissection by better identification of the extent of disease as compared to microscope during surgery. Conclusion and relevance:Endoscope is a useful adjunct to the operating microscope in cholesteatoma surgeries. It is useful in not only identifying residual disease but also in decision making by identifying the extent of the disease intra-operatively.

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Endoscopic open technique in patients with middle ear cholesteatoma

Abstract: 2C.

Cited by 57 publications

References 10 publications

Minimally Invasive Transcanal Removal of Attic Cholesteatoma

Minimally Invasive Transcanal Removal of Attic Cholesteatoma

NASAL ENDOSCOPE FOR TYPE 1 TYMPANOPLASTY; PROS & CONS - AN ANALYTICAL STUDY

Use of endoscope as adjunct to microscope in cholesteatoma surgery- A non-randomized, non-controlled study

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