Transcanal Endoscopic Ear Surgery for Attic Cholesteatoma

ZHANG Jin; WANG Bing; YANG Qimei; JING Yang; WANG Yujuan; LI Shidong; LIU Hui; ZHANG Wen

doi:10.3969/j.issn.1672-2922.2017.04.007

Abstract：Objective To report surgical techniques, outcomes and application characteristics of transcanal endo-scopic ear surgery for attic cholesteatoma. Methods Data from 47 patients (28 males and 19 females;aged 15-68 years, mean=41 years) who underwent transcanal endoscopic ear surgery for attic cholesteatoma in our department from Janu-ary 2016 to January 2017 were retrospectively analyzed. During the surgery, the tragus cartilage-perichondrium compos-ite was routinely harvested for tympanoplasty after removal of cholesteatoma under an otoendoscope. Ossiculoplasty and attic reconstruction were individualized. Patients were followed up at postoperative 1, 2, 3 and 6month. Results Of the 47 patients, 32 (68%) had limited attic cholesteatoma, and 15 (32%) had protympanum/mesotympanum cholesteato-ma. Ossicles were intact in 21 cases (45%) and showed malleus/incus erosion in 26 cases (55%), with ossiculoplasty re-quired in 29 cases. There were no facial paralysis or otorrhea. The tympanic membrane and graft were intact and well healed, with no retraction or perforation after surgery. The mean preoperative air conduction threshold was 43.45± 9.56 dB HL, compared to 27.23 ± 6.89 dB HL postoperatively (P<0.01). The mean preoperative air-bone gap was 28.42 ± 6.78 dB, compared to 13.62 ± 8.67 dB postoperatively (P<0.01). Among the 29 patients who underwent ossiculoplasty, the postoperative air-bone gap was<10 dB in 11 cases, 10~20 dB in 13 cases, 20~30 dB HL in 3 cases and>30 dB in 2 cases. There were no recurrence, residual cholesteatoma or secondary surgery needed. Conclusions Stand alone transca-nal endoscopic ear surgery was a safe and effective for attic cholesteatoma.