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Endoscopic exclusive transcanal approach to the tympanic cavity cholesteatoma in pediatric patients: our experience

Presenting Author: Matilde Porcaro

Published online by Cambridge University Press:  03 June 2016

Daniele Marchioni ,
Davide Soloperto  and
Matilde Porcaro
Daniele Marchioni
Affiliation:
University Hospital of Verona
Davide Soloperto
Affiliation:
University Hospital of Verona
Matilde Porcaro
Affiliation:
University Hospital of Verona
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Abstract

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Learning Objectives: The aim of the present study is to describe our experience in the management of tympanic cavity cholesteatoma in pediatric patients, treated with endoscopic exclusive transcanal approach.

Objectives: Describe our experience in the management of tympanic cavity cholesteatoma in pediatric patients treated with endoscopic exclusive transcanal approach.

Methods: Review of surgical cases performed between January 2007 and December 2013. Patients presenting with cholesteatoma of the tympanic cavity with no mastoid involvement were included in the first group and underwent an exclusive transcanalar endoscopic approach (TEA). Patients with mastoid extension of the pathology were included in the control group and underwent a canal wall up microscopic technique (CWU).

Results: 59 ears of 54 patients were reviewed. Median age was 9.6 years (range 4–16 years). 31 cholesteatomas underwent a TEA approach, while 28 underwent a CWU approach, based on inclusion criteria. No differences from congenital vs acquired form was made. The ossicular chain was preserved in 26.6% of patients (16 ears): 42% of patients (13 ears) undergoing a TEA and 10% of patients undergoing a CWU approach (3 ears) (P = 0.006). Second look surgery was executed in 41.6% of patients (25 ears). In partial ossicular prosthesis reconstructions, the mean preoperative pure-tone average (PTA) was 29.4 dB, while the mean postoperative PTA was 27.1 dB, with a mean increase of 2.3 dB. In total ossicular prosthesis reconstructions, the mean preoperative PTA was 47.8 dB, while the mean postoperative PTA was 26.5 dB, with a mean increase of 21.3 dB. Recurrence rate was 12.9% (4 ears) for the TEA group and 17.2% (5 ears) for the CWU approach. Residual disease was present in 26.6%: 19.3% (6 ears) for the TEA and 34.4% (10 ears) for the CWU approach. The mean follow up was 36 months (range 8–88). Kaplan-Meier analysis at 36 months showed a lower recurrence risk for the TEA compared with the CWU approach, but this data was not statistically significant (P = 0.58).

Conclusion: TEA represents a feasible, minimally invasive and conservative technique for the management of pediatric middle ear cholesteatoma.