One of the main, justifiable, criticisms of the Endoscopic technique is the lack of outcomes data. The requirement for a technique to have to prove itself compared the gold standard of the microscope is understandable in surgery. Professors Presutti, Marchioni and co-authors recently published a systematic review encompassing English language publications where the endoscope was either used totally or in part during the surgery.
Seven articles and a cohort of 515 patients were included and the recurrence rate was 9.3%. Of course this compares reasonably favourably to open mastoidectomy and canal wall up mastoidectomy. Many criticisms can be made of such aggregate data including the variability of disease, institutional experience and equipment which all affect disease eradication. It does at least suggest the technique is not taking us backwards in terms of cholesteatoma removal rates in short term follow up.
Take home of Endoscopic Cholesteatoma Management:
- From an aggregate cohort of 515 patients with at least 3 year follow up. The use of the endoscope totally or in part during cholesteatoma surgery achieves at 9.3% recurrence rate.