A Novel Surgery Classification for Endoscopic Approaches to Middle Ear Cholesteatoma

Abstract

This study aimed to develop a novel surgery classification for an endoscopic approach to middle ear cholesteatoma. We retrospectively analyzed the surgical approaches and outcomes of patients with middle ear cholesteatoma. Middle ear cholesteatoma surgeries were divided into four types and two special types as follows: type I, attic retraction pocket, which only requires tympanostomy tube placement or retraction pocket resection and cartilage reconstruction; type II, cholesteatoma which is limited to the attic or in which endoscopy can confirm complete removal of mastoid cholesteatoma lesions, including type II a, requiring only use of a curette, and type II b, requiring use of an electric drill or chisel; type III, cholesteatoma not limited to the attic, in which endoscopy cannot confirm complete removal of mastoid cholesteatoma lesions, requiring the combined use of endoscope and microscope to perform endoscopic tympanoplasty and “Canal Wall Up” mastoidectomy; type IV, extensive involvement of mastoid cavity cholesteatoma lesions and/or cases with a potential risk of complications, removal of which can only be performed under a microscope for “Canal Wall Down” mastoidectomy. In addition, there were two special types: “difficult external auditory canal” and congenital cholesteatoma in children. In our system, type I and type II middle ear cholesteatoma surgery was completely performed under an endoscope alone. However, estimating the extent of the lesions, determining the choice of mastoid opening and reestablishing ventilation are the key points for an endoscopic approach to middle ear cholesteatoma. The classification of endoscopic middle ear cholesteatoma surgery may benefit the selection of surgical indications.

Keywords

otologic surgical procedure / endoscopy / cholesteatoma / middle ear

References

[1] AnikinIA, BokuchavaTA. The peculiar clinical features of different types of acquired cholesteatoma of the middle ear. Vestn Otorinolaringol, 2018, 83(3): 11-15

[2] HouZH, LiRX, YangSM. Application of Endoscopic Techniques in Middle Ear Cholesteatoma Surgeries. Chin J Otol (Chinese), 2017, 15(4): 393-397

[3] KuoCW, WuHM. Fully endoscopic laser stapedotomy: is it comparable with microscopic surgery?. Acta Otolaryngol, 2018, 138(10): 871-876

[4] KongWJ. Endoscopic ear surgery: flash in the pan or transformative innovation?. J Clin Otorhinolaryngol Head Neck Surg (Chinese), 2018, 32(6): 427-434

[5] PresuttiL, GioacchiniFM, Alicandri-CiufelliM, et al.. Results of endoscopic middle ear surgery for cholesteatoma treatment: a systematic review. Acta Otorhinolaryngol Ital, 2014, 34(3): 153-157

[6] CohenMS, BasonbulRA, KozinED, et al.. Residual Cholesteatoma during Second-Look Procedures following Primary Pediatric Endoscopic Ear Surgery. Otolaryngol Head Neck Surg, 2017, 157(6): 1034-1040

[7] YungM, TonoT, OlszewskaE, et al.. EAONO/JOS Joint Consensus Statements on the Definitions, Classification and Staging of Middle Ear Cholesteatoma. J Int Adv Otol, 2017, 13(1): 1-8

[8] WatanabeT, ItoT, FurukawaT, et al.. The Efficacy of Color-Mapped Diffusion-Weighted Images Combined With CT in the Diagnosis and Treatment of Cholesteatoma Using Transcanal Endoscopic Ear Surgery. Otol Neurotol, 2015, 36(10): 1663-1668

[9] MasterAN, FloresJM, GardnerLG, et al.. Anatomical Factors Influencing Selective Vestibular Neurectomy: A Comparison of Posterior Fossa Approaches. J Neurol Surg B Skull Base, 2016, 77(1): 19-23

[10] CuiY. Transcanal Endoscopic Ear Surgery, 2019, Xi’an, World Book Publishing Xi’an Co., Ltd.: 9

[11] LouwL. Acquired cholesteatoma pathogenesis: stepwise explanations. J Laryngol Otol, 2010, 124(6): 587-593

[12] DiacovaS, McDonaldTJ. A comparison of outcomes following tympanostomy tube placement or conservative measures for management of otitis media with effusion. Ear Nose Throat J, 2007, 86(9): 552-554

[13] KalciogluMT, CokkeserY, KizilayA, et al.. Follow-up of 366 ears after tympanostomy tube insertion: why is it draining?. Otolaryngol Head Neck Surg, 2003, 128(4): 560-564

[14] KayaI, TurhalG, OzturkA. Results of endoscopic cartilage tympanoplasty procedure with limited tympanomeatal flap incision. Acta Otolaryngol, 2017, 137(11): 1174-1177

[15] SchröderS, ReinekeU, LehmannM, et al.. Chronic obstructive eustachian tube dysfunction in adults: long-term results of baloon eustachian tuboplasty. HNO, 2013, 61(2): 142-151

[16] MarchioniD, VillariD, Alicandri-CiufelliM, et al.. Endoscopic open technique in patients with middle ear cholesteatoma. Eur Arch Otorhinolaryngol, 2011, 268(11): 1557-1563

[17] PalvaT, NorthropC, RamsayH. Aeration and drainage pathways of Prussak’s space. Int J Pediatr Otorhinolaryngol, 2001, 57(1): 55-65

[18] MarchioniD, MattioliF, Alicandri-CiufelliM, et al.. Trans canal endoscopic approach to the sinus tympani: a clinical report. Otol Neurotol, 2009, 30: 758-765

[19] BistaM, MahatoNB, RegmiD. Innovative Method of Using Endoscope in Postoperative Canal Wall Down Mastoid Cavity. JNMA J Nepal Med Assoc, 2018, 56(211): 650-653

[20] AzevedoAF, SoaresAB, GarchetHQ, et al.. Tympanomastoidectomy: Comparison between canal wall-down and canal wall-up techniques in surgery for chronic otitis media. Int Arch Otorhinolaryngol, 2013, 17(3): 242-245

[21] QuanY, LiuJ, LiuZ, et al.. Detection of hypoplasia of bony cochlear nerve canal by the opening threshold of virtual endoscopy: a pilot study. Acta Radiol, 2014, 55(3): 318-324

[22] MahdoufiR, TaziN, BarhmiI, et al.. Bilateral primitive cholesteatoma of external auditory canal with congenital stenosis. Int J Surg Case Rep, 2016, 24: 108-111

[23] YinD, LiC, JuanH, et al.. Morphological Characteristics of Osseous External Auditory Canal and Its Relationship With External Auditory Canal Cholesteatoma in Patients With Congenital Aural Stenosis. Otol Neurotol, 2017, 38(10): 1528-1534

[24] ItoT, KubotaT, WatanabeT, et al.. Transcanal endoscopic ear surgery for pediatric population with a narrow external auditory canal. Int J Pediatr Otorhinolaryngol, 2015, 79(12): 2265-2269

[25] PalvaT, NorthropC, RamsayH. Aeration and drainage pathways of Prussak’s space. Int J Pediatr Otorhinolaryngol, 2001, 57(1): 55-65

[26] KerckhoffsKG, KommerMB, van StrienTH, et al.. The disease recurrence rate after the canal wall up or canal wall down technique in adults. Laryngoscope, 2016, 126(4): 980-987

[27] MishiroY, SakagamiM, KitaharaT, et al.. The investigation of the recurrence rate of cholesteatoma using Kaplan-Meier survival analysis. Otol Neurotol, 2008, 29(6): 803-806

[28] CrowsonMG, RamprasadVH, ChapurinN, et al.. Cost analysis and outcomes of a second-Look tympanoplasty-mastoidectomy strategy for cholesteatoma. Laryngoscope, 2016, 126(11): 2574-2579