Transcanal Endoscopic Ear Surgery for Middle Ear Cholesteatoma

Glikson, Eran; Yousovich, Ruth; Mansour, Jobran; Wolf, Michael; Migirov, Lela; Shapira, Yehoshua

doi:10.1097/mao.0000000000001395

Cited by 30 publications

(21 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Not surprisingly, areas of limited visualization, such as the sinus tympani and epitympanum, have higher rates of recurrence (≥20%) . Application of the endoscope to the otologic armamentarium has implications for cholesteatoma surgery, as it allows the surgeon to visualize difficult‐to‐access regions …”

Section: Introductionmentioning

confidence: 99%

“…5 Application of the endoscope to the otologic armamentarium has implications for cholesteatoma surgery, as it allows the surgeon to visualize difficult-to-access regions. 2,6 Recurrent cholesteatoma requires revision surgery, which contributes significantly to the cost of care. In fact, operating room costs remain among the largest contributors to healthcare expenditures.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical and cost utility of an intraoperative endoscopic second look in cholesteatoma surgery

et al. 2018

View full text Add to dashboard Cite

Objective/Hypothesis This study aimed to determine the clinical and cost‐effectiveness of endoscopes during cholesteatoma surgery. More specifically, this study hypothesized that endoscope use would reduce cholesteatoma recurrence rates and cost. Study Design Case series involving the prospective enrollment of 110 consecutive cholesteatoma patients over a 2‐year period. Methods Patients underwent cholesteatoma surgery with microscopy. During dissection, the location of the cholesteatoma was assessed. At the end of dissection and before reconstruction, the same subunits were visualized with straight and angled endoscopes for residual cholesteatoma. Hearing was analyzed before surgery and at the last possible examination. Costs were analyzed using Medicare reimbursement rates from the Centers for Medicare and Medicaid Services. Results Intraoperative endoscopic surveillance was able to detect residual cholesteatoma in 18 patients. With a 0° endoscope, residual cholesteatoma was noted in the epitympanum (two patients), sinus tympani (one patient), and the supratubal air cells (one patient). With a 45° endoscope, residual cholesteatoma was noted in the epitympanum (three patients), sinus tympani (nine patients), the supratubal air cells (two patients), and the mesotympanum (two patients). From a cost analysis, endoscopic surveillance ($6110.36 per patient) are less expensive than second look surgeries ($11,829.83 per patient), observation ($7097.20 per patient), and observation with annual magnetic resonance imaging studies ($9891.95 per patient). The patients hearing improved after surgery, consistent with previous studies. No complications were noted from the use of endoscopes. Conclusions Intraoperative endoscopic surveillance reduced recurrence in our series of 110 patients. Endoscopes are particularly useful in evaluating the epitympanum, mesotympanum, sinus tympani, and supratubal air cells. Moreover, endoscopic surveillance is cost‐effective. Level of Evidence 4 Laryngoscope, 128:2867–2871, 2018

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical and cost utility of an intraoperative endoscopic second look in cholesteatoma surgery

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Following a literature search, there was no clear patient selection criteria proposed. Both Tarabichi et al [15] and Glikson et al [16] recommended endoscopic surgery when the cholesteatoma did not extend posterior to the anterior limb of the lateral semi-circular canal. These are the same criteria we use in both our centres.…”

Section: Discussionmentioning

confidence: 99%

Audit of Outcomes of Endoscopic Cholesteatoma Ear Surgery

Diale¹,

Meyer²,

Harris³

2020

IJOHNS

View full text Add to dashboard Cite

Background: The objective of cholesteatoma surgery is not only to eradicate disease, but also reduce the risk of recurrence. While the use of the endoscope has been shown to reduce the rate of residual disease, there is currently insufficient data on recidivism and hearing outcomes following exclusive endoscopic use in cholesteatoma ear surgery. Objectives: Auditing outcomes of exclusive endoscopic surgery (EES) for the surgical management of cholesteatoma, with a secondary aim of comparing recidivism and hearing outcomes of 4 different surgical techniques, namely, EES, microscopic canal wall down (CWD), microscopic canal wall up (CWU) and combined endoscopic-microscopic techniques (CEM). Methods: A retrospective chart review was conducted at two tertiary academic hospitals in Cape Town, namely, Red Cross War Memorial Children's Hospital (RCWMH) for patients below13 years and Groote Schuur Hospital (GSH) for patients above 13 years, over a 5 year period, between January 2012 and December 2016. Results: 128 cholesteatoma surgeries overall; 110 patients were from GSH and 18 from RCWMH. Eight RCWMH patients underwent EES, 7 had CWU, 2 had CWD and 1 underwent CEM. Overall recidivism in the RCWMH population was 33% (6/18), 2 underwent EES, 2 underwent a microscopic CWU, 1 had a CWD and 1 underwent CEM. The mean postoperative hearing in this group was 40 dB from 50.3 decibels (dB) preoperatively. In the GSH group, 23 underwent an EES, 42 had a CWU, 40 underwent CWD and 5 underwent CEM. Overall recidivism for the GSH group was 17% (19/110). Of those, 7 underwent EES, 8 underwent microscopic CWU, 1 underwent CWD and 3 underwent CEM. Mean postoperative hearing was 47.4 dB from 48.4 dB preoperatively. Conclusions: The CWD technique demonstrated superior outcomes. In the GSH group, the EES approach had the same recurrence rate as CWU. Much higher recidivism was observed in the RCWMH group. Management of cholesteatoma requires a highly individualized approach to determine the most appropriate surgical treatment paradigm.

show abstract

“…Transcanal EES has been found to be an acceptable and safe technique for the exposure and eradication of middle ear and/or attic cholesteatoma. 12,13 A study by Mürbe revealed that two-handed endoscopic manipulation yields significantly smaller tremor amplitudes than one-handed manipulation; though, in clinical otological surgery, operators basically manipulate the endoscope with one hand and surgical instruments with the other. 9 Neudert analyzed the hand tremor of students during 28 days of surgical training of tympanic membrane reconstruction using both hands but did not find any significant reduction of hand tremor.…”

Section: Discussionmentioning

confidence: 99%

Three Dimensional Motion Analysis of Hand Tremors During Endoscopic Ear Surgery

et al. 2019

View full text Add to dashboard Cite

Background Endoscopic surgery is developing in various clinical specialties. During ear endoscopic surgery, a surgeon has to hold an endoscope with one hand and operate the surgical instruments with another hand. Therefore, the stability of the surgeon's hand affects the field of surgical view and quality of the surgery considerably. There are few techniques which are used during surgery to stabilize the endoscope. However, no study has evaluated the efficacy of such techniques in detail. This study examined the three dimensional movement of an endoscope to compare and evaluate the effect of various stabilization techniques to reduce the hand tremor while using the endoscope. Methods A non-randomized controlled trial involving 15 medical students was conducted in Tottori University, Japan. Subjects held an endoscope with their nondominant hand and manipulated it using three different stabilization techniques i.e. with resting the elbow on the table, resting the endoscope on the ear canal, both with the elbow on the table and endoscope on the ear canal. For the control, subjects were made to use the endoscope without any stabilization technique. The endoscopic movement was measured with and without using the stabilization techniques. Results The results obtained in this study indicated that manipulating the endoscope with resting the elbow on the table restrains both vertical (Y-axis) and optical axis (Z-axis) direction of tremor, and manipulating the endoscope by resting it on the ear canal restrains both vertical (Y-axis) and horizontal axis (X-axis) direction while the combined use of both the techniques reduces the endoscope movement in all the three X, Y and Z axes. Conclusion In conclusion, concomitant use of both techniques appears to be clinically beneficial in endoscopic ear surgery.

show abstract

Transcanal Endoscopic Ear Surgery for Middle Ear Cholesteatoma

Abstract: Transcanal endoscopic ear surgery was found to be an acceptable and safe technique for the exposure and eradication of middle ear and/or attic cholesteatoma.

Cited by 30 publications

References 22 publications

Clinical and cost utility of an intraoperative endoscopic second look in cholesteatoma surgery

Clinical and cost utility of an intraoperative endoscopic second look in cholesteatoma surgery

Audit of Outcomes of Endoscopic Cholesteatoma Ear Surgery

Three Dimensional Motion Analysis of Hand Tremors During Endoscopic Ear Surgery

Contact Info

Product

Resources

About