Endoscopic versus microscopic approach in attic cholesteatoma surgery

Purpose Compare the outcomes of primary exclusive endoscopic ear surgery with those of the microscopic ear surgery in a group of patients affected by attic cholesteatoma. Materials and methods Eighty patients suffered from attic cholesteatoma. Forty patients surgical treated with endoscopic ear surgery and forty patients surgical treated with microscopic ear surgery. Results No statistical differences were found in the parameters analysed (frequency of facial nerve dehiscence, age, disease duration, site of dehiscence) between the endoscopic and microscopic groups indicating a homogeneous selection thus providing a good comparison of the outcomes between the two groups. None of the patients in our survey developed postoperative iatrogenic facial palsy. Graft success rate was 100% in both groups. The overall operation time of endoscopic ear surgery presented a mean value of 87.8 min, while in the group of patients treated via microscopic ear surgery a lower mean value of 69.9 min was reported. The average healing time was 36.3 days for the endoscopic subgroup and 47.8 days for the microscopic subgroup. Conclusion The surgical outcomes of endoscopic ear surgery are comparable to those of the conventional approach in terms postoperative air-conduction, graft success rate and taste sensation. The analysis of postoperative pain and healing times showed better results for EES. The mean operative times of endoscopic ear surgery gradually shortened as the surgeons gained expertise in performing one-hand surgery.