ACQUIRED CHOLESTEATOMA

Management of small to medium cholesteatoma represents an ideal indication for Endoscopic Ear Surgery.

The philosophy of the minimally invasive technique is that the disease can be identified at its source in the middle ear, dissected under vision to the extent of the disease and during that dissection, an attempt is made to preserve normal mucosa and ventilation pathways of the middle ear.

Potential Advantages include:

• Better visualisation of hidden areas in the temporal bone
  
• Better disease eradication
  
• Scar avoidance, quicker healing

The following preoperative conditions should be looked for to ensure a totally transcanal approach:

• Appropriate meatus and canal size – ideally greater than 5 mm to accommodate a 3mm scope and instruments at the same time.
• Disease limited to the middle ear and not extending beyond the antrum and lateral semicircular canal (this is currently an instrument limitation issue, that is, the instruments do not allow access beyond this region).
• Disease that is not extending beyond a type B Sinus Tympani (Marchioni classification).
• No complications such as lateral semicircular canal fistula.