Systematic Review of Endoscopic Ear Surgery Outcomes for Pediatric Cholesteatoma

Abstract

Objective: Endoscopic ear surgery (EES) has been increasingly adopted to enhance visualization during otologic surgery including pediatric cholesteatoma resection. The purpose of this study is to systematically review the current literature reporting rates of residual cholesteatoma to evaluate outcomes of EES in the pediatric population. Data Sources: PubMed, Embase, Cochrane. Study Selection: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations (PRISMA), we systematically reviewed studies that reported outcomes for cholesteatoma surgery in children using the endoscope. Studies were included if they described the use of the endoscope for middle ear surgery and measured outcomes following cholesteatoma resection in pediatric patients. Data Extraction: Identified articles were assessed for study design, sample size, inclusion of pediatric population, the presence of a comparison group, outcomes measured such as: residual disease rate, recurrent cholesteatoma, audiologic outcome, quality of life measures, and complications. Data Synthesis: Fourteen articles in the literature discussed cholesteatoma outcomes in children when the endoscope was employed. Residual disease rate ranged from 0 to 22% when endoscope was used for dissection compared with 11 to 55% when endoscope was used for inspection or not at all. A meta-analysis was conducted on 11 studies. There was a significant risk reduction in residual disease rates for endoscopic dissection when compared with microscope (RR = 0.48, 95% CI = 0.37–0.63, p < 0.001). Conclusion: Among the studies included in this review, EES was associated with lower rates of residual cholesteatoma compared with traditional microscopic techniques. Additional prospective studies are needed to further assess these findings.

Postoperative Pain and Numbness in Endoscopic Ear Surgery: Patient Values and Outcomes

“…Our study is novel and clinically significant. Previous studies have demonstrated that TEES, compared to microscopic surgery, may be associated with reduced operative time [1], improved educational value [2,3], similar or better outcomes [4] for some procedures, and decreased pain/numbness [6,7]. Other work has described the prevalence of complications and perioperative outcomes (e.g., pain, taste disturbances, satisfaction of perioperative care) in ear surgery.…”

“…TEES has certain additional advantages over microscopic ear surgery. Studies have shown that TEES may have decreased operative time (e.g., for tympanoplasty) [1], increased educational value [2,3], and similar or better outcomes [4] for some procedures (despite the limitations of one-handed dissection [5]) when compared microscopic ear surgery. Moreover, TEES avoids a postauricular incision, which has been shown to minimize pain and numbness [6,7]; this may contribute to an increased patient-driven interest in TEES.…”

Assessing the Prognostic Value of the ChOLE Classification in Predicting the Severity of Acquired Cholesteatoma

“…Also, it emphasizes the importance of thorough inspection of the sinus tympani in every surgical approach. The complementary use of a rigid endoscope can expose any remnants of cholesteatoma in the sinus tympani after microscopic surgery, possibly decreasing the risk of residual disease (24,25).…”

The chronic ear: A case report of bilateral cholesteatoma in a 10-year-old boy

“…This is especially true for recesses of the tympanic cavity -the most frequent source of residual disease 12,42 . TEES is therefore associated with reduced rates of recurrence 43 .…”