[en] [en] PURPOSE: Compare the audiological results and postoperative outcomes of the endoscopic approach versus the endaural microscopic approach for treatment of attic cholesteatomas, using a randomized prospective model.
MATERIALS AND METHODS: Eighty patients were consecutively enrolled in the study and randomized into two groups of treatment of 40 patients: Group A -tympanoplasty with a microscopic endaural approach; Group B -tympanoplasty with an exclusive trans-meatal endoscopic approach. Preoperative, intraoperative and postoperative outcomes were evaluated. Hearing was assessed preoperatively and at 1 month, 3 months and 6 months after surgery in both groups.
RESULTS: There were no differences in the parameters analyzed (CT findings, patient age, disease duration, intraoperative cholesteatoma characteristics,) between the group A and B patients. No statistical difference between the two groups regarding hearing improvement, abnormal taste sensation, dizziness, post-operative pain and healing times emerged. Graft success rate was 94.5 % and 92.1 % for MES and ESS respectively.
CONCLUSION: Both microscopic and exclusively endoscopic endaural approaches offer similar and excellent results in the surgical treatment of attic cholesteatomas.
Disciplines :
Otolaryngology
Author, co-author :
Iannella, Giannicola; Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185 Rome, Italy. Electronic address: giannicola.iannella@uniroma1.it
Pace, Annalisa; Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185 Rome, Italy
Greco, Antonio; Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185 Rome, Italy
Polimeni, Antonella; Department of Oral and Maxillofacial Sciences, University of Rome, 6, Caserta St, 00161, Sapienza, Rome, Italy
Maniaci, Antonino; Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Via S. Sofia, 78, 95125 Catania, Italy
Mucchino, Alessandro; Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185 Rome, Italy
Lechien, Jérome ; Université de Mons - UMONS > Faculté de Psychologie et des Sciences de l'Educatio > Service de Métrologie et Sciences du langage
Saibene, Alberto Maria; Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
Mat, Quentin; Department of Otorhinolaryngology, C.H.U. Charleroi, Charleroi, Belgium, Faculty of Medicine and Pharmacy, University of Mons (UMons), Mons, Belgium
Gargula, Stephane; Department of Otolaryngology, Hôpital Fondation Adolphe de Rothschild, 29 Rue Manin, 75019 Paris, France
Fakhry, Nicolas; Department of Otolaryngology-Head and Neck Surgery, APHM, Aix-Marseille Univ, Hopital La Conception, Marseille, France
Simon, François; Department of Pediatric Otolaryngology, Necker-Sick Children's Hospital, AP-HP-University of Paris, Paris, France
Gioacchini, Federico Maria; ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60121 Ancona, Italy
Re, Massimo; ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60121 Ancona, Italy
Magliulo, Giuseppe; Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185 Rome, Italy
Magliulo, G., Iannella, G., Endoscopic versus microscopic approach in attic cholesteatoma surgery. Am J Otolaryngol 39:1 (2018), 25–30.
Nikolopoulos, T.P., Gerbesiotis, P., Surgical management of cholesteatoma: the two main options and the third way–atticotomy/limited mastoidectomy. Int J Pediatr Otorhinolaryngol 73:9 (2009), 1222–1227.
Hajare, P., Mathew, R.S., Singh, A., Shetty, S.S., Intraoperative classification of cholesteatoma using ChOLE classification and evaluating its treatment outcomes using inside out approach mastoidectomy. Indian J Otolaryngol Head Neck Surg 73:4 (2021), 437–442.
Roth, T.N., Haeusler, R., Inside-out technique cholesteatoma surgery: a retrospective long-term analysis of 604 operated ears between 1992 and 2006. Otol Neurotol 30:1 (2009), 59–63.
Vadiya, S., Kedia, A., Atticotomy, attic reconstruction, tympanoplasty with or without ossiculoplasty, canal plasty and cortical mastoidectomy as part of intact canal wall technique for attic cholesteatoma. Indian J Otolaryngol Head Neck Surg 67:2 (2015), 128–131.
Motegi, M., Yamamoto, Y., Akutsu, T., Nakajima, T., Takahashi, M., Sampei, S., Yamamoto, K., Udagawa, T., Sakurai, Y., Kojima, H., Retrograde mastoidectomy with canal wall reconstruction versus intact canal wall tympanomastoidectomy for cholesteatoma with minimal mastoid extension. Eur Arch Otorhinolaryngol 279:11 (2022), 5113–5121.
Lopes, Noschang, da Silva, M., Selaimen da Costa, S., André Selaimen, F., da Costa, Huve F., Lang Silva, A., Dias Toshiaki Koga, F., Martins-Costa, L.L., Bernard Rosa Nery, M., Zanardini, M., Sperling, N., Residual cholesteatoma after endoscopic-Assisted Canal wall-up tympanomastoidectomy: a randomized controlled trial. Otol Neurotol 43:7 (2022), 803–807.
Wu, N., Wang, F., Hou, Z., Yang, S., Improvement of otoendoscopic surgery for epitympanic cholesteatoma invading the mastoid. Acta Otolaryngol 139:6 (2019), 492–496.
Iannella, G., Marcotullio, D., Re, M., Manno, A., Pasquariello, B., Angeletti, D., Falasca, V., Magliulo, G., Endoscopic vs microscopic approach in stapes surgery: advantages in the middle ear structures visualization and Trainee's point of view. J Int Adv Otol 13:1 (2017), 14–20.
Angeletti, D., Pace, A., Iannella, G., Rossetti, V., Colizza, A., Di Gioia, C., Magliulo, G., Tympanic cholesterol granuloma and exclusive endoscopic approach. Am J Case Rep., 22(21), 2020, e925369.
Silva, M.N.L., Selaimen, F.A., Huve, F.D.C., Koga, F.D.T., Martins-Costa, L.L., Bergamaschi, J.A.P., Silva, A.L., da Costa, S.S., Endoscopic-Assisted Canal wall-up tympanomastoidectomy for reduction of residual cholesteatoma. Int Arch Otorhinolaryngol. 26:2 (2021), e260–e264.
Pace, A., Visconti, I.C., Iannella, G., Milani, A., Rossetti, V., Cocuzza, S., Maniaci, A., Messineo, D., Magliulo, G., Petrous bone cholesteatoma: facial and hearing preservation. Ear Nose Throat J, 19, 2021 1455613211056554.
Marchioni, D., Rubini, A., Gazzini, L., Alicandri-Ciufelli, M., Molinari, G., Reale, M., Presutti, L., Complications in endoscopic ear surgery. Otol Neurotol 39:8 (2018), 1012–1017.
Iannella, G., De Vincentiis, M., Greco, A., Vicini, C., De Vito, A., Meccariello, G., Cammaroto, G., Pelucchi, S., Magliulo, G., Endoscopic approach in second stage ossicular chain reconstruction. Am J Otolaryngol 40:5 (2019), 735–742.
Iannella, G., Angeletti, D., Manno, A., Pasquariello, B., Re, M., Magliulo, G., Malleostapedotomy in stapes revision surgery: is an endoscopic approach possible?. Laryngoscope 128:11 (2018), 2611–2614.
Bae, M.R., Kang, W.S., Chung, J.W., Comparison of the clinical results of attic cholesteatoma treatment: endoscopic versus microscopic ear surgery. Clin Exp Otorhinolaryngol 12:2 (2019), 156–162.
Moneir, W., Hemdan, A., El-Kholy, N.A., El-Kotb, M., El-Okda, M., Endoscopic transcanal attico-antrostomy versus endoscopic-assisted canal wall up mastoidectomy in management of localized cholesteatoma: a randomized clinical trial. Eur Arch Otorhinolaryngol 279:9 (2022), 4371–4378.
Toulouie, S., Block-Wheeler, N.R., Rivero, A., Postoperative pain after endoscopic vs microscopic otologic surgery: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 167:1 (2022), 25–34.
Curran, J.F., Coleman, H., Tikka, T., Iyer, A., Comparison of outcomes of endoscopic ear surgery with microsurgery for cholesteatoma: a prospective study of 91 cases with three-year follow-up. Clin Otolaryngol 47:1 (2022), 197–202.
Li, B., Zhou, L., Wang, M., Wang, Y., Zou, J., Endoscopic versus microscopic surgery for treatment of middle ear cholesteatoma: a systematic review and meta-analysis. Am J Otolaryngol, 42(2), 2021, 102451.
Manzoor, N.F., Totten, D.J., McLeod, M.E., Sherry, A.D., Perkins, E.L., Haynes, D.S., Rivas, A., Comparative analysis of recidivism after endoscopic and microscopic-based cholesteatoma resection. Otol Neurotol 43:4 (2022), 466–471.
Wu, L., Liu, Q., Gao, B., Huang, S., Yang, N., Comparison of endoscopic and microscopic management of attic cholesteatoma: a randomized controlled trial. Am J Otolaryngol, 43(3), 2022, 103378.
Tseng, C.C., Lai, M.T., Wu, C.C., Yuan, S.P., Ding, Y.F., Comparison of the efficacy of endoscopic tympanoplasty and microscopic tympanoplasty: a systematic review and meta-analysis. Laryngoscope 127:8 (2017), 1890–1896.
Choi, N., Noh, Y., Park, W., Lee, J.J., Yook, S., Choi, J.E., Chung, W.H., Cho, Y.S., Hong, S.H., Moon, I.J., Comparison of endoscopic tympanoplasty to microscopic tympanoplasty. Clin Exp Otorhinolaryngol 10:1 (2017), 44–49.
McCallum, R., Mohd Slim, M.A., Iyer, A., Audit of post-operative pain scores after endoscopic and microscopic ear surgery. Clin Otolaryngol 47:2 (2022), 369–374.
Prasad, S.C., Giannuzzi, A., Nahleh, E.A., Donato, G.D., Russo, A., Sanna, M., Is endoscopic ear surgery an alternative to the modified Bondy technique for limited epitympanic cholesteatoma?. Eur Arch Otorhinolaryngol 273:9 (2016), 2533–2540.
