Minimizing recidivism in cholesteatoma surgery by using canal wall down technique with endoscopic control

الملخص EN

Background.

Cholesteatoma surgery aims to prevent cholesteatoma recidivism (recurrent and residual disease), and to stabilize or improve hearing.

Controversies remain about canal wall up and canal wall down techniques.

Endoscopes have been used with canal wall up technique, whicli decreased recidivism but could not achieve complete eradication.

Purpose.

To evaluate the value of using otoendoscopy with canal wall down technique in minimizing cholesteatoma recidivism.

Study Design.

Prospective case series.

Methods.

A modified one stage technique for cholesteatoma surgery was used.

It included retrograde atticoantrotomy extending to mastoidectomy according to cholesteatoma extent, using endoscope to detect cholesteatoma in hidden areas and hence its removal, cartilage grafting with ossicular reconstruction, then partial cavity obliteration.

Second look surgery was done for patients with suspected recidivism.

Results.

Sixty patients (60 ears) were treated from middle ear cholesteatoma.

The age ranged from 6 to 55 years, 32 were males and 28 were females.

Preoperative endoscopic evaluation was able to detect cholesteatoma in 23.3% not seen even by microscopic examination.

Intraoperatively, endoscopes revealed hidden cholesteatoma after apparent complete removal by microscope in 72% of patients.

Second look suregry was needed for 11 patients (18.3%), and cholesteatoma recidivism was found only in 2 patients (3.3%).

Conclusion.

Using endoscopes with canal wall down mastoidectomy for cholesteatoma helped to achieve one of the lowest rates of recidivism, as it discovered and aided removing disease from hidden aiqas.

Cartilage grafting did not obscure recidivism: and may prevent recurrence as it resists retraction.