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Otology/Neurotology

(359) Outcomes of Endoscopic Congenital Cholesteatoma Removal in South Korea

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Jeong Gum Lee, MD

    Dr.
    Yonsei University College of Medicine
    Seodaemungu , Seoul-t'ukpyolsi, Republic of Korea

    • Co-Author(s)

  • MJ

    Mincheol Jung, MD

    Dr.
    Yonsei University College of Medicine
    Seoul, United States

  • JC

    Ji Eun Choi, MD

    MD
    Samsung Medical Center
    Gangnam-gu, Seoul-t'ukpyolsi, Republic of Korea

    • Senior Author(s)

  • JC

    Ji Eun Choi, MD

    MD
    Samsung Medical Center
    Gangnam-gu, Seoul-t'ukpyolsi, Republic of Korea

    • Co-Author(s)

  • In Seok Moon, MD

    Professor
    Yonsei University College of Medicine
    Seoul, United States

    • Senior Author(s)

  • In Seok Moon, MD

    Professor
    Yonsei University College of Medicine
    Seoul, United States

Disclosure(s):
Jeong Gum Lee, MD: No relevant relationships to disclose.


Introduction: Transcanal endoscopic ear surgery (TEES) provides minimally invasive transcanal access to the middle ear and improves middle ear visibility during cholesteatoma resection. However, the literature on outcomes following TEES alone for the removal of congenital cholesteatoma (CC) is lacking and limited to small series.

Methods: To assess outcomes of TEES for CC limited to the middle ear and/or mastoid antrum and to explore the risk factors associated with recidivism (ie, recurrent and/or residual cholesteatoma).
This cohort study evaluated retrospective, multicenter data for 271 children with CC who underwent TEES at 9 tertiary referral hospitals in South Korea between January 1, 2013, and December 31, 2021, and had a follow-up of at least 6 months after surgery.
Outcomes included the incidence of residual cholesteatoma and audiometric data after TEES. A multivariable analysis using Cox proportional hazards regression models was used to assess associations between cholesteatoma characteristics and recidivism, with hazard ratios (HRs) and 95% CIs reported.

Results: Of the 271 patients (mean [SD] age, 3.5 [2.9] years; 194 [71.6%] boys, 77 [28.4%] girls), 190 had Potsic stage I CC (70.1%), 21 (7.7%) had stage II, 57 (21.0%) had stage III, and 3 (1.1%) had stage IV. Thirty-six patients (13.3%) with residual cholesteatoma were found, including 15 (7.9%) with Potsic stage I, 3 (14.3%) with stage II, and 18 (31.6%) with stage III. In the multivariable analysis, invasion of the malleus (HR, 2.257; 95% CI, 1.074-4.743) and posterosuperior quadrant location (HR, 3.078; 95% CI, 1.540-6.151) were associated with the incidence of recidivism. Overall, hearing loss (>25 dB on auditory behavioral test or >30 dB of auditory evoked responses) decreased from 24.4% to 17.7% after TEES.

Conclusions: This cohort study involved the largest known population to date of CC removed by TEES. The findings suggest that TEES may be feasible and effective for the removal of CC limited to the middle ear and/or mastoid antrum in children.