Learning Objectives: To confirm that TEES with optional transcanal atticoantrotomy can be used for pediatric patients with a narrow EAC.

Introduction: Transcanal endoscopic ear surgery (TEES) is less invasive and functional procedure that offers the wide angle view of surgical field, higher magnification of fine anatomical structures and better visualization of hidden anatomical areas. We demonstrated the feasibility of TEES for the pediatric population with a narrow external auditory canal (EAC).

Methods: Thirty-nine patients ranging in age from 2 to 14 years old (median: 7.9 yrs) underwent TEES between November 2011 and March 2015. Twenty-one of these patients had surgery for cholesteatomas; fifteen for chronic otitis media; and five for malformation of the middle ear. A preoperative CT scan was performed to evaluate the middle ear disease. We evaluated the bony EAC retrospectively using ImageJ as the image processing program. The EAC bony portion was defined as the bone which surrounds the canal in sagittal CT images. The minimum and maximum Feret diameters were used as the EAC minor and major axis respectively. Transcanal endoscopic tympanoplasty was performed with a rigid endoscope with an outer diameter of 2.7 mm coupled to the full HD system. Transcanal atticoantrotomy was also performed, as necessary, on some patients to remove cholesteatomas in the antrum. We will show a video of the surgical procedure for cholesteatomas.

Results: The minor axis ranged from 3.2 to 5.9 mm (mean: 4.7 mm), while the major axis ranged from 4.8 to 10.2 mm (mean: 7.8 mm). TEES was successfully performed on each patient without having to make a retroauricular incision. Postoperative hearing levels and air-bone gap fell into an acceptable range and are comparable to those results obtained by microscopic ear surgery.

Conclusions: TEES is feasible using rigid endoscopes with an outer diameter of 2.7 mm and is effective and less invasive for pediatric patients with a narrow EAC.