Abstract
Objectives:
Determine the efficacy of otoendoscopy in detecting residual and recurrent cholesteatoma after traditional microdissection.
Methods:
Retrospective review of 273 consecutive cases on 215 patients who underwent cholesteatoma surgery with or without otoendoscopy from May 2006 to January 2013 at a tertiary referral center. Main outcome measures: The incidence of residual cholesteatoma after microsurgery that was found by angled otoendoscopes, and of recurrent cholesteatoma on second look procedures.
Results:
Otoendoscopy was used in 48% of the cases. Of the 114 canal wall down mastoidectomies, otoendoscopy was used in 11.7%. There were 47 (17.2%) second look procedures. Of the 124 cases of cholesteatoma surgeries using otoenedoscopy, residual cholesteatoma was found in 66 cases (53.2%). Residual cholesteatoma was most frequently found in the epitympanum (30.7%), followed by the sinus tympani and oval window (each at 9.6%). The overall recurrent cholesteatoma rate found on second look surgery was 5.1% (14 of 273). Cholesteatoma was found in 10 of 27 cases (37%) when otoendoscopy was used in the primary surgery, and in 11 of 20 cases (55%) when otoendoscopy was not used in primary surgery. Residual cholesteatoma was missed by microsurgery but found by otoendoscopy in 8 of 21 cases (38.1%). There was no significant difference in the locations of the residual and recurrent cholesteatoma, found by otoendoscopy or microsurgery (P = 1).
Conclusions:
Otoendoscopy can decrease the rate of residual and recurrent cholesteatoma and should be included in the armamentarium of all otologists.
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