Canal wall and ossicle chain reconstruction with tragal cartilage/perichondrium composite grafts in endoscopic resection of middle ear and antrum cholesteatomas.

Abstract

Background: Compared to the microscopic approach (MA), the endoscopic approach (EA) is more challenging for the removal of cholesteatomas and reconstruction of the ossicle chain and canal wall. We presented a surgical technique for rebuilding the canal wall and ossicle chain with tragal cartilage/perichondrium composite grafts in the resection of cholesteatomas under EA.

Methods: This retrospective study consisted of 24 cases undergoing EA (EA group) for cholesteatomas destroying the ossicles and 28 cases undergoing MA (MA group). The aim of this study was to analyze the outcome of ossiculoplasty, the stability of the reconstructed canal wall and the recurrence rate of cholesteatoma in EA group. The postoperative outcomes between TEA and MA groups were compared.

Results: In EA subgroup with an intact stapes superstructure, the pre- and postoperative air conduction (AC) thresholds and pre- and postoperative air-bone gap (ABG) were 42 ± 13.0, 37 ± 13.7, 23 ± 13.9 and 18 ± 14.8 dB, respectively. AC thresholds and ABG were significantly improved after the operation (p=0.003 and p=0.004, respectively). Gain in AC thresholds was 7.2 ± 11.1 dB in EA group and 1.6 ± 14.5 dB in MA group. There was no significant difference in the gain between two groups (p = 0.615). In EA group, two cases suffered cholesteatoma recurrence, with a recurrence rate of 8.3%. The recurrence rate was 10.7% in MA group. There was no significant difference in the recurrence rate between two groups (p = 0.772).

Conclusion: Our endoscopic method had a comparable result to MA in the treatment of cholesteatomas involving the ossicle. The technique has the advantage of leaving both a smaller surgical wound and an invisible scar. The composite graft can be easily modified for reconstruction of canal wall defects and ossiculoplasty. Patients with an intact stapes superstructure had better hearing outcomes.