published_or_final_version / Surgery / Master / Master of Surgery

Background: Endoscopic ear surgery has gained acceptance as a complementary tool to microscopic ear surgery, but perhaps not so much as an instrument for exclusive use.With this approach becoming popular, there is scarce data on cholesteatoma recidivism and hearing outcomes, when exclusively used. Objectives: Auditing outcomes of endoscopic ear surgery for the surgical management of cholesteatoma in the Groote Schuur hospital (above13 year age group) and the Red Cross War Memorial Children’s hospital (below 13 year age group) , with a secondary aim of comparing recidivism and hearing outcomes of 4 different surgical techniques for cholesteatoma resection, namely, exclusive endoscopic (EES), microscopic canal wall down (CWD), microscopic canal wall up (CWU) and combined endoscopic-microscopic techniques. Methods: A retrospective chart review was conducted at our two tertiary academic referral hospitals in Cape Town, namely, Red Cross War Memorial Children’s Hospital and Groote Schuur Hospital from January 2012 to December 2016. Results: A total of 128 cholesteatoma ear surgeries were done; 110 patients were above the age of 13 years and 18 patients were below the age of 13 years. Eight Red Cross patients underwent EES, 7 had CWU, 2 had CWD and 1 had a combined technique. Overall recidivism rate in this population was 33% (6/18), of which 2 were approached exclusively endoscopically, 2 underwent a microscopic CWU, 1 had a CWD and 1 had combined endoscopic-microscopic approach. The mean postoperative hearing in this group was 40dB compared to a preoperative mean of 50,3 decibels (dB). In the Groote Schuur group, 23 underwent an exclusive endoscopic approach; 42 had a CWU, 40 had a CWD and 5 had a combined endoscopic-microscopic approach. Overall recidivism rate for the above 13 year old group was 17% (19/110). Of those, 7 were from the endoscopic group, 8 from the CWU group, 1 from CWD group and 3 from the combined technique group. Mean postoperative hearing was 47,4dB compared to a preoperative hearing of 48,4dB. Conclusions: The CWD technique demonstrated superior outcomes in both the above and below 13 year age groups. In the above 13 year old group, the EES approach had the same recurrence rate as CWU. While paediatric cholesteatomas have much higher recidivism rates compared to adults, our below 13 year old group was too small to conclude any statistical significant differences between the different approaches, and therefore, further studies are required in this age group. Management of cholesteatoma requires a highly individualized approach that takes into account anatomic, clinical and social factors to determine the most appropriate surgical treatment paradigm