Outcomes of Using Otoendoscopy During Surgery for Cholesteatoma

  • Alaa Eldin M. Elfeky
  • Alaa O. Khazbzk
  • Wail F. NasrEmail author
  • Tarek A. Emara
  • Mohamed W. Elanwar
  • Hazem S. Amer
  • Yasser A. Fouad
Original Article


To determine the impact of using otoendoscopy at the time of primary surgery of cholesteatoma in identifying hidden “cholesteatoma remnant”. Study was prospective study. Setting was University tertiary care hospital. One hundred fifty, patients diagnosed clinically and by CT as having cholesteatoma, have been operated. 64 patients operated by using canal up technique and 86 patients operated by using canal down technique. Once all visible cholesteatoma was removed with standard microscopic techniques, otoendoscopy was utilized in every patient to identify any hidden “cholesteatoma remnant”. Despite apparent total microscopic eradication of cholesteatoma of the operated cases, otoendoscopy at time of primary surgery revealed an overall incidence of hidden cholesteatoma remnants of 18%. The incidence of hidden cholesteatoma remnants identified by otoendoscopy was 23% in the canal up group and 14% in the canal down group. Otoendoscopy should be used as an adjunct with standard microscopic technique to identify hidden cholesteatoma remnants during surgery of cholesteatoma.


Cholesteatoma Otoendoscopy Canal up Canal down Cholesteatoma remnant 



Chronic suppurative otitis media


Canal wall-down


Canal wall-up


Compliance with Ethical Standards

Conflict of interest



  1. 1.
    Nyrop M, Bonding P (1997) Extensive cholesteatoma: long term results of three surgical techniques. J Laryngol Otol 111:521–526CrossRefGoogle Scholar
  2. 2.
    Gaillardin L, Lescanne E, Morinière S et al (2012) Residual cholesteatoma: prevalence and location. Follow-up strategy in adults. Eur Ann Otorhinolaryngol Head Neck Dis 129:136–140CrossRefGoogle Scholar
  3. 3.
    Haginomori S, Takamaki A, Nonaka R et al (2008) Residual cholesteatoma: incidence and localization in canal wall down tympanoplasty with soft-wall reconstruction. Arch Otolaryngol Head Neck Surg 134:652–657CrossRefGoogle Scholar
  4. 4.
    Tomlin J, Chang D, Mc Cutcheon B et al (2013) Surgical technique and recurrence in cholesteatoma: a meta-analysis. Audiol Neurootol 18:135–142CrossRefGoogle Scholar
  5. 5.
    McKennan KX (1993) Endoscopic ‘second look’ mastoidoscopy to rule out residual epitympanic/mastoid cholesteatoma. Laryngoscope 103:810–814PubMedGoogle Scholar
  6. 6.
    Badr-Eldine M (2002) Value of ear endoscopy in cholesteatoma surgery. Otol Neurotol 23:631–635CrossRefGoogle Scholar
  7. 7.
    El-Meselaty K, Badr-Eldine M, Mandour M, Mourad M, Darweesh R (2003) Endoscope affects decision making in cholesteatoma surgery. Otolaryngol Head Neck Surg 129:490–496CrossRefGoogle Scholar
  8. 8.
    Yung MW (2001) The use of middle ear endoscopy: has residual cholesteatoma been eliminated? J Laryngol Otol 115:958–961PubMedGoogle Scholar
  9. 9.
    Ayache S, Tramier B, Strunski V (2008) Otoendoscopy in cholesteatoma surgery of the middle ear. What benefits can be expected? Otol Neurotol 29(8):1085–1090CrossRefGoogle Scholar
  10. 10.
    Abdel Baki F, Badr-Eldine M, El Saiid I, Bakry M (2002) Sinus tympani endoscopic anatomy. Otolaryngol Head Neck Surg 127:158–162CrossRefGoogle Scholar
  11. 11.
    Syms MJ, Luxford WM (2003) Management of cholesteatoma: status of the canal wall. Laryngoscope 113:443–448CrossRefGoogle Scholar
  12. 12.
    Kinney SE (1982) Five years experience using the intact canal wall tympanoplasty with mastoidectomy for cholesteatoma: preliminary report. Laryngoscope 92:1395–1400PubMedGoogle Scholar
  13. 13.
    de Zinis LO, Tonni D, Barezzani MG (2010) Single-stage canal wall-down tympanoplasty: long-term results and prognostic factors. Ann Otol Rhinol Laryngol 119:304–312CrossRefGoogle Scholar
  14. 14.
    Sanna M, Facharzt AA, Russo A et al (2009) Modified Bondy’s technique: refinements of the surgical technique and long term results. Otol Neurotol 30:64–69CrossRefGoogle Scholar
  15. 15.
    Mishiro Y, Sakagami M, Okumura S et al (2000) Postoperative results for cholesteatoma in children. Auris Nasus Larynx 27:223–226CrossRefGoogle Scholar
  16. 16.
    Badr-Eldine M (2002) Value of ear endoscopy in cholesteatoma surgery. Otol Neurotol 23:631–635CrossRefGoogle Scholar
  17. 17.
    Presutti L, Marchioni D, Mattioli F et al (2008) Endoscopic management of acquired cholesteatoma: our experience. J Otolaryngol Head Neck Surg 37:481–487PubMedGoogle Scholar
  18. 18.
    Ayubi A, Gill M (2011) Oto-endoscopy for resduial disease after radical and modified radical mastoidectomy for cholesteatoma. JUMDC 2(1):33Google Scholar
  19. 19.
    Ayache S, Tramier B, Strunski V (2008) Otoendoscopy in cholesteatoma surgery of the middle ear: what benefits can be expected? Otol Neurotol 29:1085–1090CrossRefGoogle Scholar
  20. 20.
    Presutti L, Gioacchini F, Alicandri-Ciufelli M, Villari D, Marchioni D (2014) Results of endoscopic middle ear surgery for cholesteatoma treatment: a systematic review. Acta Otorhinolaryngol Ital 34:153–157PubMedPubMedCentralGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2017

Authors and Affiliations

  • Alaa Eldin M. Elfeky
    • 1
  • Alaa O. Khazbzk
    • 1
  • Wail F. Nasr
    • 1
    Email author
  • Tarek A. Emara
    • 1
  • Mohamed W. Elanwar
    • 1
  • Hazem S. Amer
    • 1
  • Yasser A. Fouad
    • 1
  1. 1.Department of Otolaryngology-Head and Neck Surgery, Faculty of MedicineZagazig UniversityZagazigEgypt

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