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Comparison of endoscopic and microscopic management of attic cholesteatoma: A randomized controlled trial
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  • Lihua Wu,
  • Qinghua Liu,
  • Bo Gao,
  • Shaopeng Huang,
  • Ning Yang
Lihua Wu
Fujian Medical University ShengLi Clinical College Fujian Provincial Hospital
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Qinghua Liu
Fujian Medical University ShengLi Clinical College Fujian Provincial Hospital
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Bo Gao
Chinese PLA General Hospital
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Shaopeng Huang
Fujian Medical University ShengLi Clinical College, Fujian Provincial Hospital
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Ning Yang
The First Affiliated Hospital of China Medical University
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Abstract

Objectives: To compare the endoscopic approach to manage attic cholesteatoma with conventional microscopic technique. Design: Randomized controlled trial. Participants: A total of 190 patients (192 ears) diagnosed with attic cholesteatoma extending to the antrum area (stages Ib and II) were randomly assigned into two groups: one undergoing endoscopic approach and the other undergoing the microscopic technique. Main outcome measures: The two groups were compared in terms of preoperative and intraoperative findings, access to hidden areas expressed in terms of the Middle Ear Structural Visibility Index (MESVI), mean operative time, and postoperative findings. Results: No difference in the parameters of the preoperative and intraoperative findings analyzed (patient age, computed tomography findings, disease stage, and intraoperative cholesteatoma characteristics) was observed between the endoscopic and microscopic groups. The median MESVI for the endoscopic group was better than that for the microscopic group (P<0.05). The mean operating time using the endoscopic approach was less than that using the microscopic approach (P<0.05). The median postoperative pain score in the endoscopic group was lower than that in the microscopic group (P<0.05). No significant difference was found between the two groups in terms of taste sensation, air-bone gap closure at the end of 4 weeks, and vertigo experienced at the end of the first week. When long-term surgical outcomes were assessed 1 year postoperatively, five patients in the microscopic group had recurrence, four had cartilage displacement, three had perforation, and five had retraction pocket formation. In the endoscopic group, four patients had disease recurrence, three had cartilage displacement, two had perforation, and four had retraction pocket formation. Conclusion: Endoscopic management of limited attic cholesteatoma showed definite advantages over the conventional microscopic approach, such as providing better visualization, requiring less postoperative time, subjecting the patients to less pain, and decreasing the incidence of complications.

Peer review status:IN REVISION

04 Feb 2021Submitted to Clinical Otolaryngology
12 Feb 2021Assigned to Editor
12 Feb 2021Submission Checks Completed
14 Feb 2021Review(s) Completed, Editorial Evaluation Pending
21 Feb 2021Editorial Decision: Revise Minor