Endoscopic transcanal surgery of pars tensa cholesteatoma: Preliminary results.

INTRODUCTION AND OBJECTIVES: The aim of the present study is the assessment of exclusive endoscopic ear surgery for the management of primarily acquired pars tensa cholesteatoma, which is commonly linked to the failure of the Eustachian tube leading to the formation of retraction pockets. MATERIALS AND METHODS: Patients suffering from primarily acquired pars tensa cholesteatoma, who underwent primary surgery in our clinic, between 2014 and 2018 were included in this retrospective study. The disease was classified according to the EAONO/JOS system. Exclusive endoscopic ear surgery was performed for patients without mastoid involvement, while a microscopic-endoscopic tympanoplasty was carried out in case of mastoid extension. We assessed the recidivism rate during the follow-up. RESULTS: Cholesteatomas belonged to stage I in 28% of cases, to stage II in 68% and only one patient was stage III. Only a portion of the pars tensa was involved in 13 instances, the whole pars tensa in 3 and both the tensa and the flaccida in 9. 17 out of 25 patients underwent exclusive endoscopic ear surgery and 8 needed a combined approach. We discovered 1 recurrence and 6 residual diseases. CONCLUSIONS: With only one case of recurrence in our series, we showed how pars tensa cholesteatoma cannot be exclusively explained through Eustachian tube dysfunction, but also through a ventilation blockage between the Eustachian tube and other mesotympanic areas due to the formation of intratympanic folds. Endoscopic ear surgery proved highly effective in the control of recurrences and it should be considered the treatment of choice.

Endoscopic transcanal surgery of pars tensa cholesteatoma: Preliminary results / Cirugía endoscópica transcanal del colesteatoma de la pars tensa: resultados preliminares

Introduction and objectives: The aim of the present study is the assessment of exclusive endoscopic ear surgery for the management of primarily acquired pars tensa cholesteatoma, which is commonly linked to the failure of the Eustachian tube leading to the formation of retraction pockets.Materials and methodsPatients suffering from primarily acquired pars tensa cholesteatoma, who underwent primary surgery in our clinic, between 2014 and 2018 were included in this retrospective study. The disease was classified according to the EAONO/JOS system. Exclusive endoscopic ear surgery was performed for patients without mastoid involvement, while a microscopic–endoscopic tympanoplasty was carried out in case of mastoid extension. We assessed the recidivism rate during the follow-up.ResultsCholesteatomas belonged to stage I in 28% of cases, to stage II in 68% and only one patient was stage III. Only a portion of the pars tensa was involved in 13 instances, the whole pars tensa in 3 and both the tensa and the flaccida in 9. 17 out of 25 patients underwent exclusive endoscopic ear surgery and 8 needed a combined approach. We discovered 1 recurrence and 6 residual diseases.ConclusionsWith only one case of recurrence in our series, we showed how pars tensa cholesteatoma cannot be exclusively explained through Eustachian tube dysfunction, but also through a ventilation blockage between the Eustachian tube and other mesotympanic areas due to the formation of intratympanic folds. Endoscopic ear surgery proved highly effective in the control of recurrences and it should be considered the treatment of choice. (AU)

Introducción y objetivos: El objetivo del presente estudio es la evaluación de la cirugía endoscópica exclusiva del oído para el manejo del colesteatoma de la pars tensa adquirido primario, que comúnmente está relacionado con la falla de la trompa de Eustaquio que conduce a la formación de bolsas de retracción.Materiales y métodosEn este estudio retrospectivo se incluyeron pacientes con colesteatoma de la pars tensa adquirido primario, que se sometieron a cirugía primaria en nuestra clínica, entre 2014 y 2018. La enfermedad se clasificó según el sistema EAONO/JOS. En pacientes sin afectación mastoidea se realizó únicamente cirugía endoscópica de oído, mientras que, en caso de extensión mastoidea, se realizó timpanoplastia microscópica-endoscópica. Se evaluó la tasa de recidiva durante el seguimiento.ResultadosEl 28% de los colesteatomas pertenecían al grado I, el 68% al grado II y solo un paciente estaba en el grado III. Solo una porción de la pars tensa estuvo afectada en 13 casos, toda la pars tensa en tres y tanto la tensa como la fláccida en nueve. Se sometieron a cirugía endoscópica exclusiva del oído 17 de 25 pacientes y ocho necesitaron un abordaje combinado. Descubrimos una recurrencia y seis enfermedades residuales.ConclusionesCon un solo caso de recurrencia en nuestra serie, mostramos cómo el colesteatoma de la pars tensa no puede explicarse exclusivamente por una disfunción de la trompa de Eustaquio, sino también por un bloqueo de la ventilación entre la trompa de Eustaquio y otras áreas mesotimpánicas debido a la formación de pliegues intratimpánicos. La cirugía endoscópica de oído demostró ser altamente eficaz en el control de las recurrencias y debe considerarse el tratamiento de elección. (AU)