Endoscopic diving technique for hearing preservation in managing labyrinth-invading cholesteatomas


MÜLAZİMOĞLU S., MEÇO C.

EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY, cilt.280, sa.4, ss.1639-1646, 2023 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 280 Sayı: 4
  • Basım Tarihi: 2023
  • Doi Numarası: 10.1007/s00405-022-07635-w
  • Dergi Adı: EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, BIOSIS, CAB Abstracts, EMBASE, MEDLINE, Veterinary Science Database
  • Sayfa Sayıları: ss.1639-1646
  • Anahtar Kelimeler: Transtympanic surgery, Cholesteatoma, Endoscopic ear surgery, Under-water technique, Labyrinthine fistula, Membranous labyrinth, FISTULA, MANAGEMENT, SURGERY, CLOSURE
  • Ankara Üniversitesi Adresli: Evet

Özet

Purpose Complete removal of the matrix over the existing fistula in the event of an extensive cholesteatoma with labyrinth invasion can result in total deafness. This study aimed to present a novel method of underwater endoscopic labyrinth dissection using continuous steroid irrigation (CSI) and systemic steroid administration for hearing preservation. Methods The endoscopic diving technique (EDT) was used to dissect semicircular canals, revealing the underwater anatomy of membranous labyrinth structures, in two cadaver temporal bones. EDT with CSI was used in three clinical cases with extensive cholesteatoma. Results On cadaver temporal bones, the anatomy of the lateral (LSC), superior (SSC), and posterior membranous semicircular canals with their respective ampullas and common crus was documented. In the first case managed with transcanal EDT, the LSC was eroded across almost its entire length. The fallopian canal was circumferentially eroded at the second genu and part of the mastoid segment. The cholesteatoma matrix was completely removed, and the membranous LSC was preserved. In the second and third cases, we were able to remove the cholesteatoma matrix along the eroded bony semicircular canals while keeping the membranes intact. No sensorineural hearing loss was detected in the postoperative masked pure-tone audiometry at a mean follow-up time of 12 months or cholesteatoma recurrence at the follow-up imaging. Conclusions EDT with CSI can be safely utilized in the course of temporal bone labyrinth dissections and provides advantages during cholesteatoma removal over the eroded labyrinth on preservation of the membranous structures, and thus may help preserve cochlear function.