Value Of Ear Endoscopy In Cholesteatoma Surgery.Ppt


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International congress on cholesteatoma, The Hague Netherlands, June 2004

Value Of Ear Endoscopy In Cholesteatoma Surgery.Ppt

  1. 1. Value of ear endoscopy in cholesteatoma surgery Ali ABBAS Hôpital Nord Marseilles France
  2. 2. Is an adjunct to the microscope, not a substitute!
  3. 3. OTOENDOSCOPY USES Educational Patient records Diagnosis Therapeutic: Positive assessment of retrotympanum Check adequacy of tympanoplasty Unique assessment of Eustachian tube
  4. 4. Autoclaved endoscopestranscanal Video control transmastoid Steril cover cable
  5. 5. Study Follow-up period: 18-28 months Closed technique total of acquired cholesteatoma opereted from 1993 to 2003 Variables analysed: 4 groups: n= 942 A- primary cholesteatoma withintact ossicular chain (n=123) 127 B- primary cholesteatoma with 13%damaged ossicles (n=243) C- 2nd look cholesteatoma(n=279) 815 cholesteatoma without D- throublesome cavities endoscopyrehabilitation (n=297) 87% cholesteatoma with endoscopy
  6. 6. REQUIREMENTS-well ventilated middle earLIMITATIONS-Bony structures-Fibrous tissue-Bleeding-Visual limitation todifferentiate pathology-Ossicular chain 2nd look 4 Acquired Cholesteatoma Groups Cholesteatoma n=276; 29% Damaged ossicles n=243; 26% Primary cholesteatoma n=366; 39% Intact ossicles n=123; 13% TCR n=297; 32%
  7. 7. TRANSCANAL ENDOSCOPY OF MIDDLE EAR LIMITATIONS size of the ear canal ossicular chain lens easily soiled bleeding
  8. 8. TRANSCANAL ENDOSCOPY OF MIDDLE EAR APPLICATIONS DIAGNOSIS - middle ear diseases EXAMINATION -incus stapes joint -retrotympanum EVALUATION -perilymphatic fistula SURGERY In selected cases such as: -retraction pockets -small perforations
  9. 9. F ow st st ow p rw stfr
  10. 10. Total of endoscope-assisted microsurgery operations n=127 Primary 2nd look cholesteatomacholesteatoma n=70 damaged ossicles n=40 56% n=52 31% 42% intact ossicles n=18 14% TCR n=17 13%
  11. 11. Primary cholesteatoma n=369 Endoscopy n=70 19% Endoscopy n=299 81% Primary cholesteatomaPrimary cholesteatoma with damaged with intact ossicular chain ossicles n=126 n=243 Endoscopy n=18 ENDOS 14% WITHOUT 52 191 21% Without 79% endoscopy n=108 86%
  12. 12. ENDOSCOPY AS COMPLEMENTARY HELP IN MIDDLE EAR SURGERY Transcanal & Transmastoid routes4mm,O°,30° 1mm 2.7mm 0° 30° 45°,70° Control of cholesteatoma removal Control of the functional surgery Second look exploration
  13. 13. Transmastoid endoscopy
  15. 15. Endoscopic Second Look
  16. 16. 2nd look cholesteatoma n=279 with endoscopy without n=40endoscopy 14% n=236 86% 2nd look non systematic: -Half of children -Third of adult patients Cholesteatoma 2nd stage found in: -35% of first stage by only microsurgery -19% of first stage performed by endoscope-assisted microsurgery
  17. 17. Endoscopic Second Look