Endoscopic management of cholesteatoma: long-term results.

OBJECTIVES: This report evaluates long-term results of transcanal endoscopic management and surveillance of cholesteatoma.

METHODS: Sixty-nine ears with acquired cholesteatoma underwent endoscopic transcanal tympanotomy and atticotomy to access and completely remove the sac. Reconstruction with a composite tragal graft was performed in 38 ears, and the cavities were packed open in 31 ears. Office-based endoscopic surveillance and follow-up were performed.

RESULTS: Forty-three ears were operated on with the patient under local anesthesia, and 58 were done on an outpatient basis. Three cases were converted into postauricular tympanomastoidectomy. There were no iatrogenic facial nerve injuries. Bone thresholds were stable, except in 1 patient with perilymphatic fistula. Mean follow-up was 41 months, and 19 ears underwent 5 years of follow-up. Six ears required revision surgery, and 9 required office-based minor procedures.

CONCLUSIONS: An endoscopic technique allows transcanal, minimally invasive management and surveillance of cholesteatoma with long-term results that compare well to those of postauricular methods.