Endoscopic Management of Primary External Auditory Canal Cholesteatoma: Outcomes and Technical Considerations.

Objective: Primary external auditory canal cholesteatoma (PEACC) represents a rare otologic entity, and the optimal role of endoscopic intervention remains undefined. This study evaluated the technical feasibility and clinical outcomes of endoscopic management for this condition.

Patients: Patients diagnosed with PEACC between 2012 and 2022 were enrolled. Posttreatment surveillance was maintained for all participants, ensuring at least 1 year of follow-up.

Intervention: Endoscopic approach and management for PEACC.

Methods: In the nonoperative treatment group, subjects underwent meticulous keratin debris removal and saline irrigation using the endoscope for visualization. Subjects underwent transcanal exclusive endoscopic ear surgery (TEES), endoscopic-assisted surgery, or canal wall-down mastoidectomy with obliteration in the operative treatment group.

Main outcome measurement: Treatment success was defined as a dry, fully epithelialized, self-cleaning ear.

Results: Sixty-five patients who completed the treatment protocols were enrolled. PEACC was categorized as stage II, III, and IV in 7, 41, and 17 cases, respectively. Successful nonoperative treatment using the transcanal endoscopic approach was achieved in 41 patients. TEES and endoscopy-assisted surgery was performed in 9 and 8 patients, respectively. Canal wall-down mastoidectomy with obliteration was performed in 7 patients with the far-advanced stage IV. Recurrence was observed in 1 case, necessitating revision surgical intervention.

Conclusion: Endoscopic intervention is the treatment of choice for PEACC. In cases of limited disease, TEES alone typically achieves excellent outcomes, resulting in a dry, clean, and healed external auditory canal, while extensive cases often require a combined endoscopic and open surgical approach for optimal control.