Biomaterial Database

Residual Cholesteatoma After Endoscope-guided Surgery in Children. 2016

Adrian L James, and Sharon Cushing, and Blake C Papsin

*Department of Otolaryngology-Head and Neck Surgery, University of Toronto †Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.

OBJECTIVE Endoscopes can facilitate surgery within tympanomastoid recesses that are not visible with the operating microscope. This study investigates whether use of endoscopes to guide dissection of cholesteatoma leads to lower rates of residual cholesteatoma than using the endoscope only for inspection after microscope-guided dissection. METHODS Comparative cohort study. METHODS Tertiary pediatric center. METHODS Two hundred thirty-five patients with acquired or congenital cholesteatoma in children <18 years having intact canal wall surgery and follow-up >12 months. METHODS Comparison of group (A) microscope surgery followed by endoscopic inspection, with group (B) endoscope-guided dissection. METHODS Residual cholesteatoma rates, controlling for site of initial cholesteatoma, detection by second-stage surgery, and length of follow-up. RESULTS Analysis of all patients showed endoscopic dissection was associated with less residua in the middle ear (risk difference = 0.12; p = 0.026, Kaplan-Meier log rank analysis; number needed to treat = 9) but not at other sites. When restricting analysis to ears that were evaluated with second look surgery, no significant reduction in residual disease was found after endoscopic dissection at any site (e.g., retrotympanic residua: 12% Group A versus 7% Group B (NS, Fisher exact test). Endoscopic dissection allowed more permeatal surgery. No complications were attributable to endoscope use. Wound complications occurred in 4% of open cases. CONCLUSIONS Endoscopes enhance surgical access to tympanomastoid recesses. In conjunction with the availability of the operating microscope, angled instruments, and KTP laser, endoscope-guided dissection provides a small incremental benefit for prevention of residual cholesteatoma, and facilitates a minimally invasive approach.

UI	MeSH Term	Description	Entries
D008297	Male		Males
D008853	Microscopy	The use of instrumentation and techniques for visualizing material and details that cannot be seen by the unaided eye. It is usually done by enlarging images, transmitted by light or electron beams, with optical or magnetic lenses that magnify the entire image field. With scanning microscopy, images are generated by collecting output from the specimen in a point-by-point fashion, on a magnified scale, as it is scanned by a narrow beam of light or electrons, a laser, a conductive probe, or a topographical probe.	Compound Microscopy,Hand-Held Microscopy,Light Microscopy,Optical Microscopy,Simple Microscopy,Hand Held Microscopy,Microscopy, Compound,Microscopy, Hand-Held,Microscopy, Light,Microscopy, Optical,Microscopy, Simple
D002648	Child	A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL.	Children
D002675	Child, Preschool	A child between the ages of 2 and 5.	Children, Preschool,Preschool Child,Preschool Children
D004724	Endoscopy	Procedures of applying ENDOSCOPES for disease diagnosis and treatment. Endoscopy involves passing an optical instrument through a small incision in the skin i.e., percutaneous; or through a natural orifice and along natural body pathways such as the digestive tract; and/or through an incision in the wall of a tubular structure or organ, i.e. transluminal, to examine or perform surgery on the interior parts of the body.	Endoscopic Surgical Procedures,Surgical Procedures, Endoscopic,Endoscopic Surgical Procedure,Endoscopy, Surgical,Surgical Endoscopy,Surgical Procedure, Endoscopic,Procedure, Endoscopic Surgical,Procedures, Endoscopic Surgical
D005260	Female		Females
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000293	Adolescent	A person 13 to 18 years of age.	Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D013517	Otorhinolaryngologic Surgical Procedures	Surgery performed on the ear and its parts, the nose and nasal cavity, or the throat, including surgery of the adenoids, tonsils, pharynx, and trachea.	Otorhinolaryngologic Surgical Procedure,Otorhinolaryngological Surgical Procedures,Procedure, Otorhinolaryngologic Surgical,Procedures, Otorhinolaryngologic Surgical,Surgical Procedure, Otorhinolaryngologic,Surgical Procedures, Otorhinolaryngologic,Otorhinolaryngological Surgical Procedure,Procedure, Otorhinolaryngological Surgical,Procedures, Otorhinolaryngological Surgical,Surgical Procedure, Otorhinolaryngological,Surgical Procedures, Otorhinolaryngological
D015331	Cohort Studies	Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics.	Birth Cohort Studies,Birth Cohort Study,Closed Cohort Studies,Cohort Analysis,Concurrent Studies,Historical Cohort Studies,Incidence Studies,Analysis, Cohort,Cohort Studies, Closed,Cohort Studies, Historical,Studies, Closed Cohort,Studies, Concurrent,Studies, Historical Cohort,Analyses, Cohort,Closed Cohort Study,Cohort Analyses,Cohort Studies, Birth,Cohort Study,Cohort Study, Birth,Cohort Study, Closed,Cohort Study, Historical,Concurrent Study,Historical Cohort Study,Incidence Study,Studies, Birth Cohort,Studies, Cohort,Studies, Incidence,Study, Birth Cohort,Study, Closed Cohort,Study, Cohort,Study, Concurrent,Study, Historical Cohort,Study, Incidence