Comparison of the Efficacy of Endoscopic Continuous Perfusion Combined With Y-Shaped Incision and Microscopic Retroauricular Incision in the Treatment of Attic Cholesteatoma: A Randomized Prospective Study.

Abstract

Objective: This study aimed to compare the efficacy of continuous perfusion of underwater bone grinding combined with a Y-shaped incision versus a microscopic posterior ear incision in the treatment of attic cholesteatoma. Study Design: Clinical trials were prospective studies from the Northern Jiangsu People's Hospital. Research Object: Adult patients with middle ear cholesteatoma requiring ear surgery agreed to participate between September 2019 and September 2023 (age > 18). The procedure utilized hard otoendoscopy with diameters of 2.7 mm, and angles of 0°, 30°, 45°, and 75°, along with absorbable microstripping ions, attractive knives, and various microinstruments. The preoperative evaluation included high-resolution computerized tomography (CT) of the temporal bone, pure tone audiometry, and hard otoscopy. The main outcome measures included the diagnosis of residual or recurrent disease through clinical examination and/or magnetic resonance imaging consistent with cholesteatoma. Intraoperative operation time, postoperative complications, postoperative pain scores, and preoperative and postoperative hearing test results were recorded. Results: A total of 80 ears were included in the study (79 patients). The mean ages for the experimental and control groups were 46.70 ± 9.86 and 48.53 ± 11.63 years, respectively. All surgeries were performed under general anesthesia. The most common sites of cholesteatoma were the posterior superior tympanic chamber (n = 75, 94%), anterior superior tympanic chamber (n = 42, 53%), posterior middle tympanic chamber (n = 25, 31%), and tympanic antrum (n = 23, 28.7%). Intraoperative ossicular chain reconstruction was performed in 64 cases (86%). The follow-up period ranged from 13 to 48 months, with an average of 30 months. The recurrence rates of cholesteatoma were 5.26% (n ≤ 2) and 11.9% (n ≤ 5) in the experimental and control groups, respectively. Conclusions: Treatment of intramastoid cholesteatoma using otoscopic continuous perfusion underwater bone grinding combined with a Y-shaped incision offers several advantages over the removal of middle ear cholesteatoma via otomicroscopic incision. These advantages include better hearing recovery, shorter operative time, smaller incisions, faster postoperative recovery, less postoperative pain, and reduced surgical bleeding.