Clinical Research Directory

Comparison of Outcomes of Microscopic Mastoidectomy With and Without Check Endoscopy

Cholesteatoma is a serious otological condition and a major challenge for otolaryngologists worldwide. If left undetected and untreated, it can erode the surrounding bone, ear ossicles, facial nerve canal, bony labyrinth or intracranial cavity, resulting in varying grades of hearing loss, facial paralysis, vertigo or intracranial complications. The main management is complete surgical excision, traditionally performed under the microscope. The main problem in management is recidivism, either as residual disease or as recurrence. These limitations can be reduced with the complementary use of the endoscope, which allows visualization of hidden areas of the middle ear. In recent years, the otoendoscope, used either exclusively or as an adjunct to the microscope, has gained popularity in cholesteatoma surgery. The main benefit of this combination is identification of residual cholesteatoma and prevention of recurrence. This randomized controlled trial was conducted in the Department of ENT, Shaikh Zayed Hospital, Lahore. Eligible participants were allocated by lottery method to two groups. Group A underwent microscopic mastoidectomy (canal wall up or canal wall down) without check endoscopy. Group B underwent microscopic mastoidectomy followed by check endoscopy in the same surgical session. All participants were operated on under general anesthesia by the same senior consultant otolaryngologist, with the researcher as assistant. Participants were followed up in the outpatient department at 1, 3 and 6 months. Both groups were compared for residual cholesteatoma and recurrence of cholesteatoma. The study measures the role of check endoscopy as an adjunct to microscopic cholesteatoma surgery in terms of identifying residual cholesteatoma and the rate of subsequent recurrence. The findings add to local scientific data on cholesteatoma management and may help improve the combined microscopic and endoscopic approach to mastoidectomy for cholesteatoma excision.

Evolution of Surgery for Middle-ear Cholesteatoma After the Introduction of Exclusive Endoscopic Ear Surgery

This retrospective observational study describes the evolution of surgical management of middle-ear cholesteatoma at Nice University Hospital over a 12-year period (January 2012 to December 2023), following the introduction of exclusive endoscopic ear surgery (EES) in September 2017. The study compares disease control (residual disease, recurrence, revision surgery) and audiometric outcomes (air-bone gap) between the pre-EES period (January 2012 to August 2017) and the post-EES period (September 2017 to December 2023), and between exclusive endoscopic, microscopic, and combined surgical approaches within the post-EES period. The aim is to characterize the patterns of surgical approach selection and to derive a practical guide for the appropriate use of EES in everyday cholesteatoma surgery.