AB122. SOH24AB_120. Looking toward the horizon: a decade using an endoscopic approach in cholesteatoma management, what have we learned?

Background: Over the past two decades, endoscopic ear surgery (EES) has increasingly been used in the management of cholesteatoma. Whether as the primary modality or as part of an endoscopic-assisted approach there have been various refinements in technique over time as well as the equipment employed. We audited our practice to determine rates of recurrence in cholesteatoma surgery using the endoscope compared with traditional microscopic techniques to develop more stringent selection criteria. As well as analysing our experience with new technology such as Piezosurgery as its use has evolved in the specialty.

Methods: A retrospective review was undertaken of all otology cases performed by a single senior otologist at a tertiary referral centre.

Results: A total of 528 cases were reviewed, 351 (66.5%) microscopic and 177 (33.5%) endoscopic procedures. In total, 94 procedures were carried out for cholesteatoma, 67 (71.3%) open and 27 (28.7%) endoscopic. In the endoscopic cholesteatoma cohort 4 patients recurred and had to have further open surgery, with a recurrence rate of 14.8% observed.

Conclusions: EES has a rapidly evolving role within the otology realm. Case selection is vitally important, particularly in complex cholesteatoma cases. No clear guidelines exist to identify those cases amenable to total EES versus endoscope-assisted or open. This has led to the development of selection criteria at our centre as well as the introduction of other emerging surgical techniques such as Piezosurgery in combination with the endoscope. As the field develops, so should guidance around suitability for a total endoscopic approach.

Keywords: Audit; cholesteatoma; endoscopes; mastoidectomy; otology