Related Experiment Video
Updated: Mar 24, 2026
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Pediatric Endoscopic Cholesteatoma Surgery
Jacob B Hunter1, M Geraldine Zuniga1, Alex D Sweeney1
1The Otology Group, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Insights
Pediatric endoscopic cholesteatoma surgery shows comparable hearing outcomes and disease recurrence rates to traditional microscopic methods. This study highlights similar safety and efficacy for endoscopic approaches in children.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Technology
Background:
- Cholesteatoma is a skin growth in the middle ear, often requiring surgical removal.
- Endoscopic techniques offer minimally invasive alternatives for ear surgery.
Purpose of the Study:
- To review a single center's experience with pediatric endoscopic cholesteatoma surgery.
- To compare surgical and audiologic outcomes of endoscopic versus microscopic cholesteatoma removal in children.
- To identify common locations of residual cholesteatoma after endoscopic removal.
Main Methods:
- A case series with chart review of pediatric patients (<19 years) undergoing cholesteatoma removal.
- Comparison of outcomes (residual disease, complications, audiometry) between total endoscopic ear surgery (TEES), combined endoscopic-microscopic surgery, and microscopic surgery.
- Analysis of 76 ears from 66 patients with an average follow-up of 18.8 months.
Main Results:
- Endoscopic cases required fewer mastoidectomies compared to microscopic cases (P = .049).
- While second-look procedures were more frequent in endoscopic cases (51.7% vs 21.3%, P = .006), residual disease rates were similar (20.0% vs 40.0%, P = .38).
- Total endoscopic ear surgery (TEES) showed significant improvement in air-bone gap (P = .009), with no reported complications.
Conclusions:
- Pediatric endoscopic cholesteatoma surgery demonstrates comparable hearing outcomes, recurrence rates, and complication profiles to traditional microscopic techniques.
- Endoscopic approaches are a viable and safe option for pediatric cholesteatoma management.
- Further research may explore the specific benefits of TEES for audiologic improvement.
Objectives:
(1) To describe and review a single center's pediatric endoscopic cholesteatoma experience, including surgical and audiologic outcomes. (2) To assess the most common locations of residual cholesteatoma following endoscopic removal.
Study Design:
Case series with chart review.
Setting:
Tertiary otologic referral center.
Subjects:
Patients <19 years of age who underwent cholesteatoma removal with either endoscopic or microscopic visualization.
Methods:
In a comparison of patients who underwent total endoscopic ear surgery (TEES), combined endoscopic-microscopic surgery, or microscopic surgery, analyzed outcomes included locations and incidence of recurrent and residual cholesteatoma, complications, and audiometric testing.
Results:
Sixty-six patients (mean age, 10.9 years; range, 4-18 years; 43.4% female) with 76 ears met inclusion criteria. The average overall follow-up was 18.8 months (range, 6.7-48.3). Forty-seven (61.8%) ears underwent microscopic removal of cholesteatoma; 29 (38.1%) ears underwent combined endoscopic-microscopic removal; and 8 (10.5%) ears underwent TEES removal. Significantly more mastoidectomies were completed in microscopic cases as compared with endoscopic cases (P = .049). Though second-look procedures occurred in 15 (51.7%) endoscopic cases and 10 (21.3%) microscopic cases (P = .006), the rate of residual disease was 20.0% and 40.0% in endoscopic and microscopic cases, respectively (P = .38). When controlling for preoperative hearing, only the air-bone gap for TEES demonstrated significant improvement (P = .009). No complications were noted.
Conclusion:
The present report describes our experience with pediatric endoscopic cholesteatoma surgery, demonstrating similar hearing outcomes, rates of recurrence and residual disease, and complication rates as compared with traditional microscopic techniques.
