Role of endoscopic control with canal wall down [CWD] in decreasing cholesteatoma recidivism

ABSTRACT

To evaluate the role of otoendoscope in conjunction with conventional otomicroscopic surgery of canal wall down technique; to inspect hidden areas and decrease rate of recidivism in cholesteatoma surgery. Also, to assess the role of partial obliteration of mastoid [leaving open attic] to decrease cavity problems of open technique. This study was conducted on 25 patients with cholesteatoma. Initial CWD technique was done for all cases in a trial to reduce recidivism. After complete removal of cholesteatoma matrix, otoendoscoy was used to inspect hidden areas, the incidence and sites of discovered cholesteatoma were recorded. Reconstruction of hearing mechanism and partial obliteration of mastoid were done. Follow up was done for 2 to 4 years and a C.T. scan was made after 1 to 2 years for every patient and a second look mastoidoscopy was carried out when needed. The incidence and site of recidivism was reported, and compared with the C.T. scan results. The use of otoendoscope after removal of cholesteatoma by otomicroscopic surgery lead to discover of residual cholesteatoma matrix in 9 patients [36%]. The highest incidence was in sinus tympani and facial recess and the least was in hypotympanum and round window niche. After partial obliteration of mastoid, cavity problems were encountered only in one patients [4%] and was successfully managed by local treatment. The second look mastoidoscopy revealed recidivism only in 1 patient [4%]. Otoendoscopy in cholesteatoma surgery improved visualization of hidden areas and decreased rate of recidivism. Also partial obliteration of lower mastoid in CWD technique lead to decrease complications of cavity problems