Transcanal Endoscopic Ear Surgery for Cholesteatoma: Royal Belgian Society of Otorhinolaryngology

Objective: Surgery for cholesteatoma is traditionally based on microscopic approach. For several years, endoscopy developed from a combined approach as a complementary device to microscope to an exclusive transcanal approach in various fields of ear surgery. The objective of this article is to present principles, surgical techniques, and results of endoscopy in cholesteatoma surgery. Methods: All principles of transcanal exclusive endoscopic ear surgery and combined approach as a complementary device to microscopy are presented. Surgical techniques are described through surgical videos and comments. Results are reported through a review of international literature. Results: Endoscopic ear surgery in the treatment of cholesteatoma shows similar results to those of microscopic surgery according to residuals, recurrence, and hearing outcomes. Endoscopic surgery is a more complex 1-hand technique that requires time to be experienced and to have wide understanding of endoscopic ear anatomy, for dissection of anatomical space and ossicular chain, and for transcanal drilling techniques. Middle ear is the main surgical field for endoscopic ear surgery. Surgical strategy when cholesteatoma extends beyond posterior epitympanum depends on surgical experience in performing large atticotomy or microscope-assisted mastoidectomy. Conclusion: The question is not to decide whether endoscopy must substitute microscopy. The ear surgeon must be able to choose the best- suited technique for the patient. The use of one or another technique depends on the surgeon’s habits. Learning both endoscopy and micros- copy allows the surgeon to adapt his surgical strategy.