A very low rate of failure occurs in children who receive CI devices, and several factors may account for this low rate. Children who develop meningitis before CI appear to be at an increased risk of device failure.

Objective: To analyze the outcomes of the endoscopic transcanal approach for removal of early stage middle ear paraganglioma tumors (MEPT). Study design: Cases series with chart review. Setting: Two tertiary Australian Otology centers. Patients: Adult patients with middle ear paraganglioma tumors treated with transcanal endoscopic approach from 2/ 2016 to 12/2019. Tumor staging was described using the Modified Fisch-Mattox (MFM). Inclusion criteria included patients with an MFM Class A or B. Exclusion criteria included higher staged or syndromic disease. Intervention: All tumors were managed with transcanal endoscopic approach. Main outcome measures: Primary outcome measures included disease clearance and hearing measured according to the AAO-HNS guidelines. Secondary outcomes included complications, duration of surgery, and length of stay. Results: Ten patients underwent totally endoscopic transcanal resection of MEPT (9 female, mean age of 45.5 years, 70% were left sided). Mean tumor size was 6.1 mm (SD 3.4 mm). Five cases (50%) were classified using the MFM system as class A1, two cases were class A2, and three cases were class B1. Three cases required canalplasty for access but were completed entirely endoscopically. Nine of the 10 cases had complete audiometric data. Pre-and postoperative mean air conduction remained stable with a decrease in mean air-bone gap of 2.84 dB. Postoperative complications include one pinhole perforation. There were no facial nerve complications. Mean follow-up period was 10 months (range 4-25 mo) with all cases having resolution of pulsatile tinnitus and no tumor recurrence. Conclusion:The transcanal endoscopic approach for early stage MEPT offers excellent visualization and permits safe and effective removal of disease with the advantages of a minimally invasive technique for patient recovery. K e y W o r d s : E n d o s c o p y -M i d d l e e a r t u m o r -Paraganglioma-Transcanal endoscopic ear surgery.

Fig 1. Computed tomography with contrast imaging demonstrating a widened right Vidian canal (bone window, axial) and invasion of the floor of the sphenoid sinus by the larger right-sided juvenile nasopharyngeal angiofibroma (soft tissue window, coronal).