Endoscopic Versus Microscopic Management of Attic Cholesteatoma: A Randomized Controlled Trial

Abstract

Objectives To compare endoscopic transcanal approach to attic cholesteatoma with conventional microscopic transcanal technique Methods Seventy‐eight patients diagnosed with attic cholesteatoma were randomly assigned into two groups—one undergoing endoscopic approach and the other microscopic technique. The two groups were compared in terms of area of exposure, access to hidden areas in terms of Middle Ear Structural Visibility Index (MESVI), intraoperative time, postoperative pain, vertigo, long‐term hearing, and surgical outcomes. Results The mean area of exposure in endoscopic atticotomy required was less than that in microscopic group and was found to be statistically significant. The median MESVI for endoscopic group better than that for microscopic group (P < .0001). The mean operating time in endoscopic approach was less than that in case of microscopic approach, with P < .05. The median postoperative pain score in the endoscopic group was less than that in microscopic group (P < .05). No significant difference was found between two groups in terms of vertigo experienced at the end of first week and air‐bone gap closure. When long‐term surgical outcomes were assessed at 1 year, in endoscopic group, one patient had disease recurrence, one cartilage displacement, one perforation, and two had retraction pocket formation. In the microscopic group, two patients had recurrence, four cartilage displacement, one perforation, and five retraction pocket formation. Conclusion Endoscopic management of limited attic cholesteatoma has definite advantages over the conventional microscopic approach. Level of Evidence 1 Laryngoscope, 130:2461–2466, 2020

Comparison of endoscopic and microscopic management of attic cholesteatoma: A randomized controlled trial

“…Magliulo et al have made a similar research conclusion on the statistical difference between the two surgical techniques in terms of postoperative pain and healing time. 3,5 Complications In this study, there were 4 patients with recurrence and 3 patients with recurrence. No complications related to facial nerve occurred in all patients.…”

“…6 hours after operation, the pain was calculated by the numerical rating scale. The average pain score of microscopic examination group was 5.80 (4)(5)(6)(7)(8) and that of endoscopic group was 3.45(1-6), which was statistically significant (P<0.05, Figure 5A).…”

“…The exposure degree of some key structures in the complete resection of attic cholesteatoma was expressed by the middle ear structure visibility index (MESVI) (supplementary figure 1). 5 The higher the MESVI, the higher the extent of surgical exposure.…”

Comparison of outcomes of endoscopic ear surgery with microsurgery for cholesteatoma: A prospective study of 91 cases with three‐year follow‐up

“…Previous studies have demonstrated that endoscopic ear surgery for cholesteatoma is faster, 7 allows for more visibility and assessment of key structures, 1,7 and has reduced morbidity – notably pain 1,7 . Das et al 7 further remarked that procedures steadily increased in speed with its TEES cohort and suggested this was due to surgical learning curve and proficiency in haemostasis. However, Killeen et al 6 stated there was no difference in surgical time and Magliulo suggested TEES was slower 10 .…”

Endoscopic-Assisted Canal Wall-up Tympanomastoidectomy for Reduction of Residual Cholesteatoma

“…8 9 10 In a historical cohort, James et al compared the results of a group of patients operated with endoscopes and another with the conventional microscopic technique and demonstrated a small benefit in the second group. 9 Arindam Das et al 11 conducted a randomized controlled trial and described a smaller bone drilling area and shorter surgical time in initial attic cholesteatomas.…”