Learning Objectives:

Background: The aim of combined approach tympanoplasty is to middle ear and mastoid eradicate the disease and obtain dry ear whilst preserving the structure and function of the middle ear as far as possible. Facial recess and sinus tympani are anatomic sites that are difficult to assess with a microscope. Hence a posterior tympanotomy is used by most surgeons as a standard step for clearance of these areas. Otoendoscopy also allows excellent visualization of these areas and reduces surgical steps and time.

Aim of the study: To compare between the recurrence rate of secondary cholesteatoma following CAT surgery using either posterior tympanotomy or otoendoscopy.

Study design: Retrospective case review over a period of 10 years at a single centre.

Setting: Regional Department of Neurotology, Sheffield Teaching Hospital, UK.

Inclusive criteria: We included every CAT that was performed in adults (>16 yr), by a single surgeon (senior author), for acquired cholesteatoma between 2006 and 2015, with a 12-month disease-free interval.

Results: A total number of 152 CAT (stage 1) procedures done between 2006 and 2015 by a single surgeon were included. Of these 25 (16%) cases (ears) showed evidence recurrent cholesteatoma as demonstrated by imaging (T2 weighted non EPI MRI) needing a second look procedure. 17 of them could be retained as a closed cavity (CAT stage 2) while 8 cases were converted into an open mastoid cavity (Modified Radical Mastoidectomy). Analysed in their own subgroups the recurrence rate in those with a posterior tympanotomy was 26% (18/70 cases) whilst it was 8% (7/82 cases) in those where the otoendoscope was used.

Conclusion: Otoendoscopy provides a simple and reliable approach for managing cholesteatoma in facial recess area in combined approach typmanoplasty. When used carefully and meticulously it can be used in place of a posterior tympanotomy approach with comparable results.