[Anatomical preservation and functional reconstruction in plasma-assisted dual-endoscope combined approach surgery...

Objective:To investigate the optimization effects of the microscope-endoscope dual-approach combined with continuous perfusion plasma technology on anatomical preservation, hearing reconstruction, and perioperative outcomes in middle ear surgery. Methods:A single-center prospective cohort study enrolled 125 patients with middle ear cholesteatoma who underwent surgery in the Department of Otorhinolaryngology Head and Neck Surgery, at Chengdu Sixth People's Hospital between July 2023 and January 2025. Participants were allocated to a dual-endoscope group（n=65, plasma-assisted dual-endoscope surgery） and a traditional microscope group（n=60, conventional microscopic drill surgery）. Primary outcomes included:①Posterior ear canal wall preservation rate（GradeⅠ: complete; Grade Ⅱ: partial defect<30%）;②Air-bone gap（ABG） at 6 months postoperatively;③Perioperative indicators（healing time, blood loss）;④Complications. Results:The dual-endoscope group demonstrated significant advantages across multiple outcome measures: ①Anatomical preservation: Higher GradeⅠ+Ⅱ posterior wall preservation（93.8%[61/65]vs 40.0%[24/60]; OR=25.1, 95%CI 9.8-64.3, P<0.001）;②Hearing reconstruction: Greater ABG improvement（[18.4±5.0]dB vs [12.0±4.5]dB; P=0.003）; higher proportion achieving air-conduction threshold ≤30 dB HL（69.4%[43/62]vs 35.1%[20/57],P<0.001）;③Perioperative metrics: 53.8% shorter wound healing time（[7.0±1.4]d vs [13.0±2.0]d; P<0.001）; reduced blood loss（[24.0±6.5] mL vs [70.0±14.8]mL; P<0.001）; ④Complications: Higher vertigo resolution ≤2 days（92.3%[60/65]vs 80.0%[48/60]）; lower taste dysfunction（1.5%[1/65]vs 15.0%[9/60]）; reduced granuloma formation（4.6% vs 26.7%; χ²=12.56, P<0.001）; decreased tinnitus exacerbation（3.1% vs 13.3%, P<0.01）. Conclusion:The dual-endoscope approach, combining multi-angle visualization with plasma-assisted precise ablation and hemostasis, facilitates a paradigm shift from destructive resection to dual preservation of anatomy and function in middle ear surgery.