Comparison of the outcomes of endoscopic versus microscopic approach in cholesteatoma surgery: a randomized clinical study

Abstract

BackgroundEndoscopic ear surgery is a new, less invasive otologic procedure. Since 1990s, it has been grown in prominence because of anatomical and physiological theories. It offers a view of hidden places, avoids mastoidectomies and endaural vertical and postauricular incisions, and has many other benefits over microscopic surgery. The purpose of this study was to distinguish the difference between the outcomes of microscopic and endoscopic cholesteatoma surgery.MethodsEighty individuals who were diagnosed with cholesteatoma participated in this randomized clinical research. Patients were randomly allocated into two equivalent treatment groups. One group submitted to tympanoplasty via microscopic ear surgery and the other group had exclusive trans-canal endoscopic ear surgery. All patients had preoperative otomicroscopic and radiologic assessment to ensure cholesteatoma diagnosis. Audiological evaluations were also obtained.ResultsThere was no discernible difference in the tested groups’ operational times, air-bone gaps, or air conduction. The endoscopic surgery group healed significantly more quickly than the microscopic surgery group (5.4 0.5 vs 7.7 0.5 weeks, p > 0.001). The frequency of residual lesions (5.0% vs 22.5%, p = 0.023) and recurrence (7.5% vs 27.5%, p = 0.019) was significantly lower in the endoscopic group of patients.ConclusionsWhen comparing healing times, rates of residual disease and rates of recurrence, endoscopic surgery clearly outperforms microscopic surgery. The endoscope encourages visualization and magnification of anatomy while being less invasive thanks to its improved picture quality, lighting, and capacity to “see around the corner.” Additionally, a significant portion of viable mastoid tissues and healthy mucosa were preserved.