Comparison of transcanal endoscopic ear surgery (TEES) and microscopic ear surgery (MES) in treating limited cholesteatoma.

OBJECTIVE

This study aimed to evaluate the efficacy, hearing outcomes, and resource utilization of microscopic ear surgery (MES) compared with transcanal endoscopic ear surgery (TEES) in patients with limited cholesteatoma.

METHODS

We performed a retrospective review of 39 patients (43 ears) with limited cholesteatoma treated between January 2008 and October 2015 at a regional medical center in Taiwan. Patients were divided into the MES group (23 ears) and the TEES group (20 ears). Assessed outcomes included residual or recurrent disease, complications, hearing results (pre- and postoperative air-conduction [AC], bone-conduction [BC], and air-bone gap [ABG] thresholds in dB HL, hearing gain, and the proportion of ears achieving ABG <20 dB), and resource utilization (hospital stay, surgical time, and anesthesia time). Postoperative audiometry was conducted at least 6 months after the final surgery or at the last available follow-up.

RESULTS

TEES was performed in 46.5% (20/43) of ears. Patients in the TEES group were more likely to be female, younger, and to have right-sided lesions or undergo atticotomy. No significant differences were found in residual or recurrent disease rates or major complications between the two groups. The TEES group showed better postoperative hearing outcomes (AC: 35.7 ± 16.7 vs. 49.2 ± 18.7 dB HL, P = 0.029; ABG: 15 vs. 30 dB HL, P = 0.002; hearing gain: 10.4 ± 9.9 vs. 0.19 ± 11.6 dB HL, P = 0.005; ABG <20 dB: 75% vs. 31.3%, P = 0.017); however, these differences may be partly attributable to a higher rate of simultaneous ossiculoplasty in the TEES group compared with staged reconstruction in the MES group. The TEES group also demonstrated lower resource utilization (median hospital stay: 2 vs. 3 days, P = 0.002; surgical time: 156.0 ± 32.59 vs. 190.9 ± 32.67 min, P = 0.001; anesthesia time: 190.5 ± 34.79 vs. 223.7 ± 31.77 min, P = 0.001).

CONCLUSION

In limited cholesteatoma, TEES provided disease control comparable to MES and was associated with reduced resource utilization. Apparent advantages in hearing restoration were observed in the TEES group; however, these findings should be interpreted cautiously given differences in ossicular reconstruction timing and approach. Prospective studies with longer follow-up and standardized reconstruction protocols are needed.