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Introduction <p>Surgery is the definitive treatment for cholesteatoma. Recidivism is a major concern in this subset of patients after surgery. Residual disease is a common factor that contributes to recidivism. The middle ear cavity has many clefts and crevices which can be involved by cholesteatoma such as sinus tympani and anterior epitympanum. These areas are difficult to visualise with traditional microscopic technique. Angles endoscopes allow the surgeon to inspect around the corners and facilitate complete removal of cholesteatoma from these hidden areas. This study aims to evaluate the utility of a 4&#xa0;mm 30-degree rigid endoscope in surgery for chronic otitis media – squamous disease (cholesteatoma) in a tertiary care centre.</p> Materials and Methods <p>All patients diagnosed with chronic otitis media-squamous disease undergoing surgical treatment were enrolled consecutively in the study. All enrolled patients underwent detailed ENT examination including oto-endoscopic examination. Surgical management included canal wall down or canal wall up procedure done as per the extent of disease and preference of the operating surgeons. The procedure was done using the traditional microscopic technique. Once the surgeon is satisfied of clearing all cholesteatoma, a 30-degree rigid endoscope was used to inspect the hidden areas (anterior epitympanum/ supratubal recess, sinus tympani, facial recess, hypotympanum and aditus) for residual disease. The anatomical extent of the cholesteatoma was also staged intra-operatively using the STAMCO system.</p> Results <p>50 ears were included in the study. 32 (64%) were males. Canal wall up and canal wall down procedures were done in 28 (56%) and 22 (44%) ears respectively. Residual cholesteatoma detected with endoscopic examination after microscopic clearance in 5 (10%) ears, residual disease were seen in anterior epitympanum, sinus tympani and aditus. 35 (70%) ears had stage III cholesteatoma (STAMCO). All the ears with residual cholesteatoma had stage III cholesteatoma.</p> Conclusion <p>30-degree angled rigid endoscope is useful tool to detect residual cholesteatoma and can be used as an adjunct to the traditional microscopic technique. The incidence of residual cholesteatoma detected by endoscopy after microscopic clearance was 10%. The aditus is also a hidden area where one can leave behind cholesteatoma during canal wall up procedures while using the microscopic technique.</p>

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Combined Micro-Endoscopic Technique in Surgical Mangement of Chronic Otitis Media- Squamous Disease

  • 期刊论文

  • 发表日期：

    2025年7月30日

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  • Jude Christenson,
  • Navneet Kumar,
  • Ashish Varghese,
  • Sunil Sam Varghese

摘要

Introduction

Surgery is the definitive treatment for cholesteatoma. Recidivism is a major concern in this subset of patients after surgery. Residual disease is a common factor that contributes to recidivism. The middle ear cavity has many clefts and crevices which can be involved by cholesteatoma such as sinus tympani and anterior epitympanum. These areas are difficult to visualise with traditional microscopic technique. Angles endoscopes allow the surgeon to inspect around the corners and facilitate complete removal of cholesteatoma from these hidden areas. This study aims to evaluate the utility of a 4 mm 30-degree rigid endoscope in surgery for chronic otitis media – squamous disease (cholesteatoma) in a tertiary care centre.

Materials and Methods

All patients diagnosed with chronic otitis media-squamous disease undergoing surgical treatment were enrolled consecutively in the study. All enrolled patients underwent detailed ENT examination including oto-endoscopic examination. Surgical management included canal wall down or canal wall up procedure done as per the extent of disease and preference of the operating surgeons. The procedure was done using the traditional microscopic technique. Once the surgeon is satisfied of clearing all cholesteatoma, a 30-degree rigid endoscope was used to inspect the hidden areas (anterior epitympanum/ supratubal recess, sinus tympani, facial recess, hypotympanum and aditus) for residual disease. The anatomical extent of the cholesteatoma was also staged intra-operatively using the STAMCO system.

Results

50 ears were included in the study. 32 (64%) were males. Canal wall up and canal wall down procedures were done in 28 (56%) and 22 (44%) ears respectively. Residual cholesteatoma detected with endoscopic examination after microscopic clearance in 5 (10%) ears, residual disease were seen in anterior epitympanum, sinus tympani and aditus. 35 (70%) ears had stage III cholesteatoma (STAMCO). All the ears with residual cholesteatoma had stage III cholesteatoma.

Conclusion

30-degree angled rigid endoscope is useful tool to detect residual cholesteatoma and can be used as an adjunct to the traditional microscopic technique. The incidence of residual cholesteatoma detected by endoscopy after microscopic clearance was 10%. The aditus is also a hidden area where one can leave behind cholesteatoma during canal wall up procedures while using the microscopic technique.