Comparison of microscopic and transcanal endoscopic ear surgery for Naim stage I-III external auditory canal cholesteatoma.

BACKGROUND

Although both microscopic and endoscopic techniques are used in external auditory canal cholesteatoma surgery, their comparative efficacy remains unclear.

OBJECTIVE

To compare the outcomes of microscopic and transcanal endoscopic treatments for Naim stage I-III external auditory canal cholesteatoma.

METHODS

A retrospective analysis was conducted on patients diagnosed with Naim stage I-III external auditory canal cholesteatoma (EACC) between November 2015 and November 2025. Clinical characteristics were compared between the transcanal endoscopic ear surgery (TEES) group and microscopic ear surgery (MES) group.

RESULT: TEES had shorter operative time (46.45 ± 25.61 vs. 65.24 ± 44.98 min) and time to complete epithelialization (28.3 ± 4.7 vs. 45.8 ± 3.2 days) than MES (both p < 0.05). No postoperative cholesteatoma recurrence or EAC stenosis/atresia occurred in TEES. Conversely, MES complications included isolated recurrence (n = 2, 4.4%), isolated EAC stenosis/atresia (n = 1, 2.2%), concurrent recurrence and stenosis (n = 3, 6.7%), and transient facial paralysis (n = 1, 2.2%).

CONCLUSION

Surgical management of EACC should be tailored to the extent of the lesion. For Naim stage I-III cases, TEES represents a safe and effective minimally invasive modality.