Endoscopic open technique in patients with middle ear cholesteatoma

The objective of this study was to describe an endoscopic open “centrifugal” technique used to treat middle ear cholesteatoma with antral and periantral extension, using a retrospective chart and video review of a case series performed in a university tertiary referral center. Charts and videos of patients who underwent middle ear endoscopic surgery from January 2007 to September 2009 were reviewed. Patients who were treated with endoscopic “centrifuge” open techniques were included in the study. Surgical indications were collected and the surgical technique described. The final study group consisted of 12/150 subjects (9 males and 3 females with a mean age of 40 years). All 12 patients who underwent endoscopic open tympanoplasty had antral, periantral or mastoid involvement of cholesteatoma with or without posterior canal wall erosion. They had sclerotic mastoids with the presence of the antrum and, in some cases, small periantral mastoid cells. In 9/12 patients, external auditory canal reconstruction was performed with a cartilage graft. In 3/12 patients, canal reconstruction was not performed. No subjects required a meatoplasty of the external auditory canal. Endoscopic “centrifugal” open techniques can be an option in the surgical management of middle ear cholesteatoma involving antral and periantral mastoid cells, in the case of sclerotic mastoids. Further study will be necessary to examine the long-term consequences of the endoscopic “centrifugal” open technique. Level of evidence: 2C.