Endoscope affects decision making in cholesteatoma surgery

The aim of the present study was to evaluate the use of intraoperative otoendoscopy as a factor that could influence surgical decision-making in cholesteatoma surgery.

The material of this study included 82 ears with acquired cholesteatoma that were operated on. They were divided into 4 groups according to the surgical technique chosen and the use of the endoscope. Group I included 22 ears that underwent canal wall-down (CWD) tympanomastoid surgery, group II included 20 ears that underwent CWD tympanomastoid surgery with intraoperative use of endoscopy, group III included 20 ears that underwent canal wall-up (CWU) tympanomastoid surgery, and group IV included 20 ears that underwent CWU tympanomastoid surgery with intraoperative use of endoscopy. Endoscopy was used as a complementary tool to microscopy. The follow-up period ranged from 12 to 48 months.

Intraoperative remnants of cholesteatoma matrix were detected during both CWU and CWD by the use of the rigid endoscope. However, its incidence was higher in the CWU group (50%) than in the CWD (30%) group. Most of these remnants were in the sinus tympani (37.5%). The mean duration of follow-up was 18.19 (+/-8.7) months. Postoperative residual cholesteatoma was much higher in the CWU group (25%) than in the CWD group (5%). All residuals were from groups of patients in whom intraoperative endoscopy was not used in the primary surgery.

Our results showed that the use of the endoscope gave the surgeon better control over the pathology, thus achieving better eradication. Stated differently, the use of the endoscope raised the surgeon's confidence level about total removal and thus encouraged the surgeon to keep the canal wall intact while removing cholesteatoma in hidden areas. Therefore, the use of endoscope could be considered an additional tool that may affect decision-making in cholesteatoma surgery.