International congress on cholesteatoma, The Hague Netherlands, June 2004

1. Value of ear endoscopy in
cholesteatoma surgery
Ali ABBAS
Hôpital Nord Marseilles France

2. Is an adjunct to the microscope,
not a substitute!

3. OTOENDOSCOPY USES
Educational
Patient records
Diagnosis
Therapeutic:
Positive assessment of
retrotympanum
Check adequacy of
tympanoplasty
Unique assessment of
Eustachian tube

4. Autoclaved endoscopes
transcanal
Video control
transmastoid
Steril cover cable

5. Study
Follow-up period: 18-28 months
Closed technique total of acquired cholesteatoma opereted
from 1993 to 2003
Variables analysed: 4 groups: n= 942
A- primary cholesteatoma with
intact ossicular chain (n=123)
127
B- primary cholesteatoma with
13%
damaged ossicles (n=243)
C- 2nd look cholesteatoma
(n=279)
815 cholesteatoma without
D- throublesome cavities endoscopy
rehabilitation (n=297) 87%
cholesteatoma with
endoscopy

6. REQUIREMENTS
-well ventilated middle ear
LIMITATIONS
-Bony structures
-Fibrous tissue
-Bleeding
-Visual limitation to
differentiate pathology
-Ossicular chain
2nd look 4 Acquired Cholesteatoma Groups
Cholesteatoma
n=276; 29%
Damaged ossicles
n=243; 26%
Primary
cholesteatoma
n=366; 39%
Intact ossicles
n=123; 13%
TCR n=297; 32%

7. TRANSCANAL ENDOSCOPY OF MIDDLE EAR
LIMITATIONS
size of the ear canal
ossicular chain
lens easily soiled
bleeding

8. TRANSCANAL ENDOSCOPY OF MIDDLE EAR
APPLICATIONS
DIAGNOSIS
- middle ear diseases
EXAMINATION
-incus stapes joint
-retrotympanum
EVALUATION
-perilymphatic fistula
SURGERY
In selected cases such as:
-retraction pockets
-small perforations

9. F ow
st
st ow
p
rw
st
fr

11. Total of endoscope-assisted microsurgery operations
n=127
Primary
2nd look cholesteatoma
cholesteatoma n=70 damaged ossicles
n=40 56% n=52
31%
42%
intact ossicles
n=18
14%
TCR
n=17
13%

12. Primary cholesteatoma
n=369
Endoscopy
n=70
19%
Endoscopy
n=299
81%
Primary cholesteatoma
Primary cholesteatoma with damaged with intact ossicular chain
ossicles n=126
n=243
Endoscopy
n=18
ENDOS 14%
WITHOUT 52
191 21% Without
79% endoscopy
n=108
86%

14. ENDOSCOPY AS COMPLEMENTARY
HELP IN MIDDLE EAR SURGERY
Transcanal & Transmastoid routes
4mm,O°,30°
1mm 2.7mm
0°
30°
45°,70°
Control of cholesteatoma removal
Control of the functional surgery
Second look exploration

15. Transmastoid endoscopy

16. CONTROL OF FUNCTIONAL SURGERY

17. Endoscopic Second Look

18. 2nd look cholesteatoma
n=279
with endoscopy
without
n=40
endoscopy
14%
n=236
86%
2nd look non systematic:
-Half of children
-Third of adult patients
Cholesteatoma 2nd stage found in:
-35% of first stage by only microsurgery
-19% of first stage performed
by endoscope-assisted microsurgery

19. Endoscopic Second Look