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Surgery of Cholesteatoma in Pediatric Age: Assessment of combined micro-endoscope approach

Presenting Author: Nader Nassif

Published online by Cambridge University Press:  03 June 2016

Nader Nassif ,
Tommaso Sorrentino ,
Silvia Zorzi  and
Luca Oscar Redaelli De Zinis
Nader Nassif
Affiliation:
Children's Hospital, Spedali Civili of Bresica
Tommaso Sorrentino
Affiliation:
Spedali Civili of Brescia
Silvia Zorzi
Affiliation:
Spedali Civili of Brescia
Luca Oscar Redaelli De Zinis
Affiliation:
Spedali Civili of Brescia
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Abstract

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Learning Objectives: Use of endoscopy in ear surgery is an interesting technique by offering the possibility to be less invasive.

Introduction: Cholesteatoma in pediatric age is aggressive and necessitates an extensive surgical approach to eradicate the pathology and a long time follow up. Introduction of otoendoscopy lately gave a cue to reconsider certain standardized techniques. The aim of this study is to survey how endoscopy is evolving in our daily practice and the preliminary results obtained.

Methods: Review of medical charts of patients underwent tympanoplasty between January 1995 and December 2014. Data collected included age, sex, features of cholesteatoma, type of tympanoplasty (TPL): trascanal (TC), canal wall up (CWU) or canal wall down (CWD), technique used: microscope and or endoscope, revision surgery for recidivism. Comparison was done on surgical techniques applied before and after the introduction of endoscopy in our department, 2010.

Results: Ninety-three children, 57 M and 36 F, average age 10 (range 3 to 16) were identified for the study. Seven patients had bilateral cholesteatoma. Tympanoplasties performed were 186 divided as follows: 63% (63/100) CWU, 15 of which underwent a second look CWU and 25 underwent a second look CWD. 20% (20/100) CWD where in 10, 2 and 1 cases underwent a second, third and fourth look, respectively. Finely, 17% (17/100) underwent TC where 7 underwent a second look TC. Three out of the 7 underwent a third look and were converted in 2 cases to CWD and in 1 case to CWU. Before and after the introduction of endoscopy the corresponding 56 and 44 first look procedures were performed as follows: CWU 57% vs 45%, CWD 27% vs 16% and TC 16% vs 39%, respectively.

Conclusions: Otosurgery tends to be less invasive by avoiding mastoidectomy. Endoscopic cholesteatoma removal should be limited to disease interesting only the tympanic cavity. A long time follow up is necessary in order to compare the real benefit of endoscopy.