Otoendoscopy in the Management of Congenital Cholesteatoma

ObjectiveTo evaluate the use of otoendoscopy in the surgical management of congenital cholesteatoma.MethodsAll patients with congenital cholesteatomas were reviewed from a 10‐year prospective pediatric otological database. Otoendoscopy was primarily used to identify and remove any intraoperative residual disease after otomicroscopic excision of cholesteatoma.ResultsA total of 27 patients with congenital cholesteatoma were included. The mean age of the population was 6.9 years (range 3‐15 years); 39.2% of the cases were stage I with 35.7% stage II and 25% stage III. After surgical resection of the cholesteatoma under otomicroscopy, 4 (14.8%) were found to have involvement of the sinus tympani on endoscopy while 1 had involvement of the anterior epitympanum. The overall rate of detection of intraoperative residual cholesteatoma using the otoendoscope was 18.5%. In 2 cases the otoendoscope helped in preservation of the ossicles by facilitating dissection in the attic.ConclusionThis is the first study to define the role of otoendoscopes in congenital cholesteatoma. The enhanced access to the medial epitympanum and recesses of the mesotympanum provided by endoscopy are ideally suited to the typical locations of congenital cholesteatoma. We have found it especially beneficial in identifying and removing cholesteatoma left after otomicroscopic resection and in preserving the integrity of the ossicular chain. Consequently, lower residual disease rates and better hearing results can be anticipated as a result of endoscopic surgery.