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Updated: Jun 16, 2025
Robot-Assisted Transcanal Endoscopic Ear Surgery for Congenital Cholesteatoma
Published on: December 15, 2023
Transcanal endoscopic ear surgery for pediatric external auditory canal cholesteatoma
Yuqi Zhang1, Yuqi Feng1, Zixuan Zhao1
1Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital, Xi'an Jiaotong University, No.147, Xi Wu Lu, Xi'an, 710004, Shaanxi Province, China.
Objective:
External auditory canal cholesteatoma (EACC) is an uncommon benign disease, which occurs rarely in children. Transcanal endoscopic ear surgery (TEES) has been proved a safe and feasible technique for treating adult EACC, no study has reported TEES in pediatric EACC. The purpose of this study was to assess the safety and feasibility of using TEES to treat EACC in children.
Methods:
From January 2015 to January 2024, the pediatric patients (age <16) with EACC who underwent TEES were enrolled. The clinical features, extent of the lesion, surgical methods, and postoperative complications were assessed. The anatomic extent of EACC was graded according to the Naim's classification. The healing time which was defined as the time required to develop a dry, re-epithelialized, and self-cleaning external auditory canal.
Results:
Forty seven pediatric patients (51 ears, twenty four males and twenty three females) were included with the average age of 10.4 years. EACC was categorized as Naim stage I in 12 ears, stage II in 10 cases, stage III in 20 cases, and stage IV in 9 cases. Middle ear including tympanic membrane or ossicular chain was the most frequently involved (10 ears), followed by attics (5 ears), mastoid (3 ears) and TMJ (2 ears). There were 2 cases of ear canal atresia resulting from previous surgery for removal of cholesteatoma misdiagnosed as cerumen embolism, and 10 cases of granulation tissue blocking the ear canal. In 92 % of patients, a dry and self-cleaning external auditory canal (EAC) was maintained after a mean follow-up of 61.5 months. Median healing time was 2 weeks in patients in stage Ⅰ and stage Ⅱ, and 5 weeks in stage Ⅲ, 8 weeks in stage IV. Postoperative EAC stenosis or atresia was found in four patients, and did not improve after conservative treatment in one patient. Four cases (8 %) showed recurrence and underwent TEES again.
Conclusion:
TEES is a feasible and safe technique for the treatment of EACC in pediatric patients, with a close follow-up debridement to achieve the goal of low recurrence rate.
