Learning Objectives: 1-Understand advantages of endoscopic otologic surgery for eliminating reidual diseae. 2-Understand advantages of endoscopic otologic surgery for re-establishing ventilation. 3-Understand limitation of endoscopic otologic surgery.

Introduction: Although it has been 15 years since the introduction of operative endoscopy to ear surgery in the form of exploration of old mastoid cavities¹, there is presently tremendous variations in thoughts and practice across the globe on the role of the endoscope in cholesteatoma surgery.

Literature Review: There are increased numbers of citations on this subject especially in the last 5 years. These reports have focused on four patterns of application of operative endoscopy in ear surgery, the first and the oldest report revolve around exploration of old mastoid cavities using the endoscope with endoscopic removal of recurrent disease.¹ The second is examination of the mastoid cavity through a stab postauricular incision.² The third is the use of transcanal endoscopic evaluation and removal of disease from the sinus tympani during traditional combined tympanomastoidectomy.^3–4 The fourth is the use of transcanal endoscopic approach as the primary access to the cholesteatoma within the middle ear and the use of traditional postauricular mastoidectomy only to address the disease within the mastoid cavity proper.⁵

Best Practice Summary:

1. 1- There is little evidence in the literature, beyond the cohorts reported by the initial authors 16 years ago, to support the use of the endoscope in exploring old cavities or through a stab wound in the postauricular area.

2. 2- Transcanal Endoscopic Access to disease within the sinus tympani in combination with traditional combined tympanomastoidectomy should be incorporated into the routine management of cholesteatoma.

3. 3- Exclusive transcanal endoscopic approach to the middle ear as the primary surgical method of removal of cholesteatoma has been reported increasingly in the literature, but more data is needed to compare outcome to traditional accepted surgical treatment of cholesteatoma.