Endoscope affects decision making in cholesteatoma surgery.

Area of Science:

• Otolaryngology
• Surgical Technology
• Medical Imaging

Background:

• Cholesteatoma surgery aims for complete eradication.
• Traditional microscopy may have limitations in visualizing hidden disease areas.
• Intraoperative decision-making impacts surgical outcomes.

Purpose of the Study:

• To evaluate intraoperative otoendoscopy's influence on surgical decision-making in cholesteatoma surgery.
• To assess the efficacy of endoscopy in detecting residual cholesteatoma matrix.
• To compare outcomes between canal wall-up (CWU) and canal wall-down (CWD) techniques with and without endoscopy.

Main Methods:

• 82 ears with acquired cholesteatoma were analyzed.
• Four groups were formed based on surgical technique (CWU/CWD) and endoscopy use.
• Endoscopy served as a complementary tool to microscopy during surgery.

Main Results:

• Intraoperative cholesteatoma matrix remnants were detected by endoscopy, particularly in the sinus tympani.
• Residual cholesteatoma was significantly higher in the CWU group (25%) versus the CWD group (5%) when endoscopy was not used.
• Endoscopy use correlated with higher detection rates of residual disease in CWU (50%) vs CWD (30%) groups.

Conclusions:

• Intraoperative otoendoscopy enhances surgeon control and confidence in cholesteatoma removal.
• Endoscopy facilitates better disease eradication, potentially allowing for more conservative surgical approaches like canal wall preservation.
• The use of endoscopy can positively influence surgical decision-making, leading to improved patient outcomes.