Endoscopic management of stage-2 attic cholesteatoma: An institutional study

Abstract

Aim: All cholesteatoma cases are managed surgically under microscopic visualization since decades. But, the recurrence of the disease was found due to inadequate removal of cholesteatoma tissue from the hidden areas such as anterior attic region, tubotympanic recess, sinus tympani, and facial recess. Objectives: An angled otoendo scopes with panoramic view increases the accessibility and thereby thorough clearance of cholesteatoma which leads to better outcome. Materials and Methods: This prospective observational study evaluates the long-term results of transcanal endoscopic management of Stage-2 attic cholesteatoma. It was conducted at the Department of Otorhinolaryngology, from January 2018 to January 2020. Eighteen patients with acquired limited attic cholesteatoma had undergone endoscopic transcanal tympanotomy and atticotomy for the complete removal of cholesteatoma sac. Reconstruction of attic with a composite tragal cartilage was performed in all cases. Results: Office-based endoscopic inspection of ear in all cases was done up to 6 months in terms of graft uptake and recurrence. Postoperative hearing evaluation at 3 months and 6 months was also performed. All cases in our series had good graft uptake with improved hearing. There was no recurrence and one case had postoperative granulation which was managed with culture and sensitivity directed antibiotics and regular aural toileting. Conclusion: Thus, an endoscopic transcanal surgical management of attic cholesteatoma is a less invasive procedure with long-term results that compare well to those of postauricular microscopic approach.