Recidivism after Endoscopic Treatment of Cholesteatoma

Objective:To investigate the recidivism rate of cholesteatoma treated via endoscopic ear surgery (EES), either via transcanal endoscopic ear surgery or endoscopic assisted tympanomastoidectomy compared with a microscopic postauricular approach.Study Design:Retrospective chart review.Setting:Academic otology practice.Patients:Adult patients (18 years and older) with at least 11 months of surgical follow-up who were treated for cholesteatoma via endoscopic techniques or microscopic postauricular approach.Intervention:Use of the endoscope for cholesteatoma dissection.Main Outcome Measure:Residual or recurrent cholesteatoma identified at second look surgery or postoperative diffusion-weighted magnetic resonance imaging.Results:Fifty-nine patients treated for cholesteatoma via endoscopic techniques and 35 patients treated via microscopic postauricular approach were analyzed. The endoscopic group required significantly fewer mastoid procedures (28% versus 80%, p-value 0.001). Postoperative changes in median ABG (5dB versus 3.75dB, p=0.9519), median PTA (6.875dB versus 1.25dB, p=0.3864), and median word recognition score (0% versus 0%, p0.3302) were not significantly different between the EES and microscopic surgery groups. Median operative times were not significantly different between the two groups (182min endoscopic versus 174min microscopic, p-value 0.66). The rate of residual disease (17% EES versus 17% microscopic, p=0.959) or disease recurrence (18% endoscopic versus 20% microscopic, p=0.816) were not significantly different between the two groups.Conclusions:EES is an effective option for cholesteatoma management with similar rates of recurrent or residual disease as compared with the more traditional microscopic postauricular approach in these samples.