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Endoscopic management of cholesteatoma

Presenting Author: IL-WOO Lee

Published online by Cambridge University Press:  03 June 2016

IL-WOO Lee
IL-WOO Lee*
Affiliation:
Pusan National University Yangsan Hospital
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Abstract

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Learning Objectives: Endoscope is widely accepted instrument for minimally invasive surgical approach for many clinical field. The main benefits of endoscopic management for cholesteatoma surgery are preserving the normal anatomical structure with complete removal of disease in the complicated middle ear structure. There are two aspects of endoscopic cholesteatoma surgery: totally transcanal endoscopic surgery vs. endoscope as an adjuvant instrument. Though totally transcanal endoscopic ear surgery (TEES) can provide wide surgical view without destruction of normal anatomical structures, it has disadvantage of one hand surgery with two instrument in relatively narrow ear canal. Surgical time for the TEES is longer than in microscopic surgery, especially for the beginners. We use the endoscope for every cholesteatoma surgery as an adjuvant instrument for microscopic surgery. With combined approach from both transcanal and transmastoid approach, we use the endoscope of 45 and 70 degree for inspection of blind spot in the middle ear cavity, and remove the remnant or residual cholesteatoma with intact canal wall. The chances of canal wall down approach were reduced dramatically with this methods. This technique is very useful especially for adhesive middle ear disease, attic cholesteatoma and congenital cholesteatoma. We will present the cases of adhesive middle ear disease, attic and congenital choesteatoma with this endoscope as an adjuvant for microscopic surgery.

Endoscope is widely accepted instrument for minimally invasive surgical approach for many clinical field. The main benefits of endoscopic management for cholesteatoma surgery are preserving the normal anatomical structure with complete removal of disease in the complicated middle ear structure. There are two aspects of endoscopic cholesteatoma surgery: totally transcanal endoscopic surgery vs. endoscope as an adjuvant instrument. Though totally transcanal endoscopic ear surgery (TEES) can provide wide surgical view without destruction of normal anatomical structures, it has disadvantage of one hand surgery with two instrument in relatively narrow ear canal. Surgical time for the TEES is longer than in microscopic surgery, especially for the beginners.

We use the endoscope for every cholesteatoma surgery as an adjuvant instrument for microscopic surgery. With combined approach from both transcanal and transmastoid approach, we use the endoscope of 45 and 70 degree for inspection of blind spot in the middle ear cavity, and remove the remnant or residual cholesteatoma with intact canal wall. The chances of canal wall down approach were reduced dramatically with this methods. This technique is very useful especially for adhesive middle ear disease, attic cholesteatoma and congenital cholesteatoma.

We will present the cases of adhesive middle ear disease, attic and congenital choesteatoma with this endoscope as an adjuvant for microscopic surgery.