Comparative Analysis of Recidivism After Endoscopic and Microscopic-Based Cholesteatoma Resection.

Objectives: 1) To analyze outcomes of cholesteatoma resection utilizing postauricular microscopic and endoscopic ear surgery (EES) approaches.2) To analyze predictors of residual and recurrent cholesteatoma.

Study Design: Retrospective cohort study.

Setting: Tertiary referral center.

Patients: Three hundred seventy-five adult and pediatric patients with cholesteatoma (2012-2017).

Interventions: Patients underwent surgical resection of cholesteatoma with EES (n = 122) and microscopic (n = 253) approach.

Main Outcome Measures: Residual cholesteatoma, recurrent cholesteatoma, second-look procedures.

Results: The endoscopic cohort included significantly more pediatric cases (p = 0.0008). There was no difference in laterality, gender distribution, congenital or acquired cholesteatoma, and revision cases between the cohorts. Out of 122 EES cases, 16 (13%) developed residual disease and 9 (7%) developed recurrent disease. Of 253 microscopic cases 16 (6%) developed residual disease while 11 (4%) developed recurrent disease. Second look procedures were more commonly used in EES cohort (50 vs 18%). Single predictor analysis revealed 12 predictors for residual disease and 5 for recurrent disease. Multivariable model identified pediatric case distribution and higher disease stage to be significant predictors for both residual (p = 0.04, 0.007) and recurrent disease (p = 0.02, 0.01). EES approach was associated with a weak significance for residual disease (p = 0.049) but not recurrent disease (p = 0.34).

Conclusions: EES approach for cholesteatoma resection seems to perform similarly to microscopic approach with no difference in rates of recurrent disease. However, it is associated with a higher rate of residual disease; this may be a reflection of a greater rate of second look procedures done in this group.