Endoscopic diving technique for hearing preservation in managing labyrinth-invading cholesteatomas

Area of Science:

• Otolaryngology
• Neurosurgery
• Surgical Innovation

Background:

• Extensive cholesteatoma invading the labyrinth poses a risk of total deafness during surgical matrix removal.
• Preserving hearing is a critical challenge in managing labyrinthine cholesteatoma.

Purpose of the Study:

• To present a novel underwater endoscopic labyrinth dissection (EDT) technique using continuous steroid irrigation (CSI) for hearing preservation.
• To evaluate the safety and efficacy of EDT with CSI in cases of extensive cholesteatoma with labyrinth invasion.

Main Methods:

• Endoscopic diving technique (EDT) was employed to dissect semicircular canals in cadaver temporal bones, visualizing membranous labyrinth anatomy.
• EDT with CSI was applied in three clinical cases of extensive cholesteatoma.
• Postoperative audiometry and imaging were used to assess hearing outcomes and cholesteatoma recurrence.

Main Results:

• Detailed anatomical documentation of membranous semicircular canals was achieved in cadaveric specimens.
• Complete cholesteatoma matrix removal was performed in clinical cases, preserving the membranous labyrinth.
• No sensorineural hearing loss was detected at a mean 12-month follow-up.
• No cholesteatoma recurrence was observed on follow-up imaging.

Conclusions:

• Underwater endoscopic labyrinth dissection (EDT) with continuous steroid irrigation (CSI) is a safe and effective method for labyrinth dissection.
• The technique facilitates complete cholesteatoma removal while preserving delicate membranous labyrinth structures.
• This approach holds significant potential for preserving cochlear function in patients with extensive cholesteatoma.