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Endoscopic atticotomy for attic cholesteatomas using piezosurgery.

Chin-Kuo Chen1,2,3, Che-Fang Ho1, Chen-Yu Chien4,5

  • 1Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC.

Journal of the Chinese Medical Association : JCMA
|December 22, 2023
PubMed
Summary

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Piezosurgery scalpels offer a safer alternative to microdrills for endoscopic atticotomy in attic cholesteatoma removal, avoiding drilling injuries. While slower, this technique preserves hearing thresholds, making it a valuable option for transcanal endoscopic ear surgery.

Area of Science:

  • Otolaryngology
  • Surgical Technology
  • Medical Devices

Background:

  • Attic cholesteatomas require surgical removal, often via transcanal endoscopic ear surgery (TEES).
  • Endoscopic atticotomy involves removing the posterior lateral bony wall of the epitympanum.
  • Surgeons utilize either piezosurgery or microdrills for this bone removal within the limited operative field.

Purpose of the Study:

  • To investigate the feasibility of using piezosurgery versus microdrills for endoscopic atticotomy.
  • To compare the safety and efficacy of these two surgical tools in exenterating attic cholesteatomas.

Main Methods:

  • Retrospective chart review of patients undergoing exclusive TEES for attic cholesteatoma.
  • Comparison of piezosurgery scalpel and microdrill for excision of superior and posterior external auditory canal bones.

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  • Assessment of preoperative and postoperative hearing thresholds using pure-tone audiometry.

    • Main Results:

    • No significant differences in patient demographics or preoperative hearing between groups.
    • Piezosurgery group had a longer operative duration (135.6 min) compared to the microdrill group (117.3 min).
    • Microdrill group experienced friction injuries in 23.3% of patients; piezosurgery group had none. No bone conduction deterioration was observed with piezosurgery.

    Conclusions:

    • Piezosurgery scalpel is a potentially safer method for endoscopic atticotomy during attic cholesteatoma exenteration.
    • Piezosurgery may be slower than microdrilling but reduces the risk of surgical trauma.
    • The choice between piezosurgery and microdrill depends on balancing operative time with patient safety and hearing preservation.