Adult Case of Congenital Intratympanic Membrane Cholesteatoma

Only a few reports describe the outcomes following endoscopic ear surgery (EES) in children for chronic ear disease. We differentiate between transcanal endoscopic ear surgery (TEES), where the case is performed with only endoscopic visualization, from non-TEES, where the endoscope is not used at all or used as an adjunct to the microscope. We hypothesize that EES is an effective approach to manage middle ear pathology using a transcanal approach in most cases, and can be incorporated into a pediatric otology practice with a neutral or positive effect on outcomes. Lessons learned during this process are analyzed and discussed. Single-institution, retrospective chart review of outcomes following TEES and non-TEES in children from January 1, 2013 through July 1, 2014. Procedures included tympanoplasty, ossiculoplasty, and cholesteatoma resection. Primary outcome measures included closure rate of tympanic membrane perforations, audiometric outcomes, and complications. Surgical times were reported as secondary measures. Ninety-four patients underwent 121 middle ear procedures. TEES was performed in 51/121 of cases (42.1%). Comparison of TEES versus non-TEES cases showed no significant difference in rate of tympanoplasty closure (P > .99). The mean pure-tone improvement following TEES tympanoplasty was -7.8 dB versus -1.33 dB for non-TEES cases (P = .03). Surgical times were similar between groups. EES techniques were readily incorporated into a pediatric otology practice. A standardized EES classification system is useful for analyzing utilization patterns and results across institutions. Tympanic membrane closure rates and hearing outcomes were similar in TEES and non-TEES cases. 4. Laryngoscope, 126:732-738, 2016.

Background: The conventional method for treating cholesteatoma involves using a microscopicapproach. However, over the years, endoscopy has evolved from being a supplementary tool alongside themicroscope to becoming the primary transcanal approach in different areas of ear surgery. Purpose: Topresent a case of cholesteatoma in adult which was treated by the combination of transcanal endoscopicear surgery and mastoidectomy. Case report: An adult patient with malignant type of chronic suppurativeotitis media underwent transcanal endoscopic ear surgery and mastoidectomy. Endoscopic surgery is amore intricate single-handed procedure that demands both experience and a comprehensive knowledge ofendoscopic ear anatomy. This is essential for navigating the anatomical space, dealing with the ossicularchain, and employing transcanal drilling techniques. The primary surgical focus for endoscopic earsurgery is the middle ear. When addressing cases where cholesteatoma extends beyond the posteriorepitympanum, the surgical approach relies on the surgeon’s expertise in performing extensive atticotomyor mastoidectomy, either with or without microscope assistance. Clinical question: What is the role oftranscanal endoscopic ear surgery and mastoidectomy in adult patient with cholesteatoma? Method:Literature searching was performed with the keywords: ”cholesteatoma”, AND ”transcanal endoscopicear surgery”, AND ”mastoidectomy” through database PubMed, Proquest, and hand searching/e-book. Result: There were 3 articles relevant with the subject. Conclusion: Transcanal endoscopic ear surgery isa minimally invasive and secure procedure characterized by its low rates of complications and recurrence Keywords: transcanal endoscopic ear surgery, mastoidectomy, cholesteatoma, chronic suppurative otitis media.

Middle ear tumors are relatively rare, and among them, the diagnoses of middle ear lesions originating from cartilage-like tissue are even rarer. Use of transcanal endoscopic ear surgery (TEES) has increased in recent years because of its advantages, such as clear visual field and minimally invasive procedure. Here, we report a middle ear mass originating from cartilage-like tissue treated with TEES. A 62-year-old woman presented with progressive right-sided hearing loss. A white mass was revealed through the tympanic membrane, and pure-tone audiometry detected a mean 50.0dB conductive hearing loss. Computed tomography showed a mass in the tympanic cavity. TEES was performed for diagnosis and treatment. A white translucent tumor was observed intraoperatively, and it was completely resected. Histopathological examination confirmed the diagnosis of a mass originating from degenerated cartilage-like tissue. To the best of our knowledge, this is the first study of a middle ear mass originating from cartilage-like tissue treated with TEES. TEES with its clear visual field and precise techniques was beneficial in treating the middle ear lesions circumscribed in the tympanic cavity.

Comparative outcomes between endoscopic and microscopic approaches in pediatric type-1 tympanoplasty.

Postoperative pain after transcanal endoscopic ear surgery: A systematic literature review

Treatment results for congenital cholesteatoma using transcanal endoscopic ear surgery

This chapter will expand on Chap. 2 which focused on powered transcanal endoscopic ear surgery (TEES) by looking at the surgical setup and safety concerns related primarily to powered TEES as well as what was referred to in Chap. 2 as “non-powered TEES.” To reiterate “non-powered TEES” is not a general term used in the literature and is used here to refer to what is typically simply called TEES. Successful TEES, in general, and powered TEES, specifically, requires careful preparation including procuring the proper equipment together with properly positioning and preparing that equipment, the surgical staff, and the patient. The safety issues which also need to be addressed for powered TEES include proper use of the powered instruments within the middle ear, heat generation of light sources, and the potential impact of skull vibrations generated by these powered instruments.

Surgical results of 29 ears with congenital middle ear anomalies; Microscopic vs. endoscopic ear surgery

To compare closure rates and hearing outcomes of microscopic and endoscopic tympanoplasty in pediatric patients. Retrospective chart review. Tertiary university medical center. Pediatric patients who underwent tympanoplasty surgery by a fellowship-trained neurotologist between 2010 and 2019 with a minimum of 2 months of follow-up, a tympanic membrane perforation, and no preoperative cholesteatoma. Transcanal endoscopic tympanoplasty or microscopic tympanoplasty (MT) surgery. The primary outcome is postoperative closure of the tympanic membrane perforation, assessed using otomicroscopy at the last follow-up appointment. Secondary outcomes include operative time and changes in the air-bone gap (ABG) and pure-tone average (PTA). Two hundred eleven tympanoplasty operations were analyzed: 121 in the transcanal endoscopic ear surgery (TEES) group and 90 in the MT group. Tympanic membrane closure rates were no different between the two groups (TEES, 82.6%; MT, 88.9%; p = 0.24), and no significant association was found on multivariable analysis (TEES: odds ratio, 0.8; p = 0.61). Both groups showed improvements in the 4-month PTA and ABG and the 12-month PTA, but the 12-month ABG only improved in the TEES group ( p < 0.01). The TEES group had a shorter average operative time (109.8 versus 123.5 min; p = 0.03) and less need for a postauricular incision (2.5% versus 93.3%; p < 0.01). In pediatric tympanoplasty, TEES gives similar membrane closure and hearing outcomes as the microscopic technique, with less operative time and less need for a postauricular incision.

To compare surgical outcomes after tympanoplasty without ossiculoplasty for chronic otitis media between transcanal endoscopic ear surgery (TEES) and postauricular microscopic ear surgery (PAMES). Case-control study. Tertiary care university hospital. Consecutive patients (N = 122) who had undergone tympanoplasty without ossiculoplasty for chronic otitis media were enrolled in this retrospective study and divided into 2 groups: TEES (n = 47) and PAMES (n = 75). Middle ear condition was graded with the middle ear risk index. Hearing, repair of tympanic membrane perforation, and surgical time were assessed. The surgical success rate for hearing (air-bone gap ≤20 dB) was 95.7% in the TEES group and 84.0% in the PAMES group. Lower middle ear risk resulted in similar mean (95% CI) closure of air-bone gaps (TEES: 9.6, 6.5-12.6; PAMES: 8.0, 6.4-9.7; P = .333), whereas higher middle ear risk demonstrated significantly larger closure of air-bone gaps for the TEES group (10.1, 3.3-16.9) than the PAMES group (-0.2, -4.5 to 4.2; P = .009). The surgical success rate for repair of tympanic membrane perforation and surgical time were equivalent between TEES and PAMES. Under favorable conditions of the middle ear, TEES and PAMES resulted in similar hearing improvement by tympanoplasty without ossiculoplasty. However, under adverse conditions of the middle ear, TEES was a more beneficial approach for hearing improvement than PAMES.

BackgroundThis study compares endoscopic and microscopic tympanoplasty for the treatment of chronic otitis media (COM) without cholesteatoma.MethodsThis retrospective study included 153 ears (139 patients) treated surgically (endoscopic or microscopic tympanoplasty) for COM in the absence of cholesteatoma at our hospital between January 2008 and October 2015. The adoption of transcanal endoscopic ear surgery (TEES) or microscopic ear surgery (MES) was divided temporally (before and since 2014). Comparisons between these groups focused on the following: (I) surgical outcomes, including successful tympanic membrane healing and post-operative complications; (II) restoration of hearing; and (III) consumption of medical resources, including the duration of surgery and anesthesia. All patients had a follow-up period of at least 3 months after surgery.ResultsNo statistically significant differences were observed between the two groups regarding surgical outcome or hearing restoration. TEES resulted in the successful healing of 96.2% of ear drums, whereas MES led to successful healing in 92% (p = 0.2826) of cases. The average hearing gains following surgery were 10.27 ± 6.4 and 12.43 ± 7.46 dB in TEES and MES, respectively. The consumption of medical resources in the TEES group was lower than that of the MES group (TEES versus MES) regarding the average operating time (87.8 ± 19.01 min (mins) versus 110.2 ± 17.0 (mins) (p < 0.0001)) and the mean duration of anesthesia ((for general anesthesia patients) (122.1 ± 21.25 mins versus 145.8 ± 16.88 mins) (p ≤ 0.0001)).ConclusionsThe results indicate that TEES can achieve surgical outcomes and hearing restoration comparable to those of MES. In addition, TEES appears to be associated with shorter surgical and anesthesia time, which makes it an ideal alternative for the management of COM without cholesteatoma.Trial registrationThis study was approved by the Institutional Review Board of the Cathay General Hospital. (CGHIRB No: CGH-P105012).

To reveal the patency of the anterior epitympanic space (AES) and the surgical outcomes after transcanal endoscopic ear surgery (TEES) for attic cholesteatoma with a classification of anatomical variation of the AES. Retrospective case review. Tertiary referral center. Seventy-four ears (72 patients with early-stage (I or II) attic cholesteatoma) aged between 16 and 85 years (mean: 48.9 yr) who underwent TEES between 2015 and 2017 were analyzed. Tympanoplasty with atticoantrotomy was performed with TEES. TEES was performed using a rigid endoscope with an outer diameter of 2.7 mm. The tensor fold in the AES anatomical classification, the postoperative patency of the AES evaluated by computer tomography images, and hearing outcomes based on the American Academy of Otolaryngology and Head and Neck Surgery criteria were evaluated after TEES for early-stage attic cholesteatoma. There were 14 (18.9%) ears with a vertical tensor fold orientation, 29 (39.2%) ears with an oblique orientation, and 29 (39.2%) ears with a horizontal orientation. The total postoperative patency rate in the AES was 81.0%, without any significant difference in the anatomical variation in the AES, whereas the rate of preoperative complete tensor fold was 90.5%. Cholesteatoma recurrence was observed in three cases (4.1%), and all recurrent cases had obstructed AES. No significant difference was found in the postoperative air-bone gap regardless of the patency of the AES. Our findings indicate that TEES is useful in restoring ventilation in the AES, resulting in favorable management of cholesteatoma.

The relatively new technique of trans-canal endoscopic ear surgery (TEES) when compared to microsurgery for ossiculoplasty has advantages of better visualization and no external incision but also has the disadvantage of being a one-handed procedure. Our study aimed to compare audiometric outcomes following ossiculoplasty performed via TESS with results of microsurgery. Data from a prospective audit of 157 consecutive patients who underwent ossiculoplasty by a single otologist from 2009 to 2018 was analyzed. TEES was introduced in the department in 2014; therefore, all patients before this period underwent microsurgery. Patients were classified by surgical approach, TEES, or microsurgery. Audiological outcomes were recorded at 3 and 12months postoperatively and compared to pre-operative levels. Other variables included were the condition of stapes and reconstruction material used. Of the 157 cases, 50 were TEES and 107 were microsurgery (81 microscope only and 27 combined with endoscope). There was statistically significant improvement (p < 0.001) in AC (43.4dB pre-operatively, 36.2dB postoperatively), BC (20.3dB pre-operatively, 17.6dB postoperatively), and ABG (21.8dB pre-operatively, 16.7dB postoperatively) in the total cohort. Both groups achieved an ABG better than 20dB; 72% in TEES, 73% in the microscopic group, and there was no significant difference. There was no change in hearing at 12months when compared to 3months. No statistically significant difference was noted based on stapes condition, type of material used for ossiculoplasty, or tympanic membrane graft. TEES is safe and as effective as microsurgery in ossiculoplasty with possibly much less pain and morbidity.

To compare levels and causes of postoperative pain after cholesteatoma removal by transcanal endoscopic ear surgery (TEES) versus microscopic ear surgery (MES). Prospective case series. Tertiary referral center. One-hundred-and-sixty-one patients who had undergone middle ear surgery between February 2013 and April 2016. Comparison of postoperative pain between TEES and MES groups and among TEES and MES subgroups divided by range of bone removal. Two parameters were used to assess postoperative pain: a pain numeric rating scale (NRS) and number of times a non-steroidal anti-inflammatory drug (NSAID) was taken from postoperative days (PODs) 1 to 7. We also examined the primary factor behind postoperative pain looking at: 1) the surgical incision; 2) bone removal; and 3) number of involved middle ear regions. One-hundred-and-six patients underwent TEES and 55 underwent MES. The mean pain NRS for the 7-day postoperative period was significantly lower for the TEES group (1.1) than the MES group (2.8) (p < 0.001, Mann-Whitney U test). The number of times a NSAID was taken was lower for the TEES group (1.3 pills/wk) than the MES group (5.5 pills/wk) (p < 0.001, Mann-Whitney U test). The mean pain NRS of the TEES and MES subgroups also suggests that extent of bone removal or number of involved middle regions was less important in causing postoperative pain than presence or absence of the retroauricular incision. TEES is associated with lower postoperative pain and lower use of NSAIDs compared with MES patients.

Open-type cholesteatoma is the predictive factor for residual disease in congenital cholesteatoma treated with TEES