Completely Endoscopic Versus Microscopic Mastoid Surgery for Chronic Otitis Media with Cholesteatoma: A Randomized Controlled Trial.

Complete eradication of cholesteatoma and restoration of best possible hearing is the surgeons' goal for Chronic otitis media (COM) with cholesteatoma. For patients with chronic otitis media and cholesteatoma, the traditional surgical approach has been performed using a microscope. However, over the past 20 years, endoscopic ear surgery has evolved into a promising alternative technique. This study aimed to compare Completely endoscopic mastoid surgery (CEMS) to microscopic surgery in COM patients with cholesteatoma.This randomized controlled trial was conducted in a tertiary referral center from July 2019 to July 2021. Patients with squamous-type COM and cholesteatoma, meeting predefined inclusion criteria, were enrolled after block randomization. Endoscopic and microscopic mastoidectomies were performed in intervention and control groups respectively. The primary outcome was to compare the improvement in hearing, while secondary outcomes were duration of surgery, postoperative pain score, duration of hospital stay, recidivism rate during the study period, quality of life, and cosmesis.The study included 40 individuals with 20 patients in each group, and had well-matched demographics and disease characteristics. The mean pre-operative air conduction pure tone average reduced from 37.51 ± 5.41 dB to 30.62 ± 7.04 dB in the endoscopic group and from 43.46 ± 5.80 dB to 33.83 ± 5.99 dB in the microscopic group. Both groups yielded comparable post-operative hearing improvements, as well as no significant differences in surgical duration. However, CEMS demonstrated significantly lower postoperative pain scores (p = 0.0002) and shorter hospital stays (p = 0.013). Quality of life scores improved significantly in the CEMS group postoperatively (p = 0.021), with higher patient satisfaction regarding cosmesis.Endoscopic ear surgery emerges as an excellent alternative to microscopic ear surgery for addressing the squamous type of chronic otitis media with cholesteatoma. It not only holds promise for improved hearing outcomes but also offers the benefits of reduced post-operative pain, shorter hospital stays, enhanced cosmesis, and better patient satisfaction.

Supplementary information: The online version contains supplementary material available at 10.1007/s12070-025-05466-9.