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The conventional surgery for cholesteatoma of the middle ear is done through microscopic approaches. However, in recent year's endoscopictechniques and knowledge have greatly improved, and endoscopic surgical techniques will gain high importance in otologic surgery in the future. The aim of this study was to focus on results obtained using endoscopic surgery for the treatment of middle ear cholesteatoma. The study of the middle ear is particularly complex and an endoscopic approach represents an improvement with regard to the anatomic concepts of this region because it ensuresall round scanning of hidden areas such as the sinus tympani, facial recess, anterior epitympanic spaces, attic, hypotympanum and protympanum. Cholesteatoma surgery primarily aims to eliminate the affected region and ensures the patient with a safe and dry ear.
The main problems regarding attic cholesteatoma removal are residual and recurrence and the former is due to insufficient surgical removal of the epidermal matrix, and classically presents a pearl-like aspect. Insufficient resection may be due a very fine epidermal matrix or middle-ear inflammation. Actually, the view during microscopic surgery is defined by the narrowest segment of the ear canal, this fundamental limitation has compelled surgeons to create a collateral port through the mastoid to gain keyhole access to the attic. Inspite of the illumination and magnification offered by the operating microscope, it has distinct limitations. The persistence of physio-pathologic phenomena that determined cholesteatoma development, presents as a new attic contraversion that requires a further surgical approach to avoid the reformation of attic cholesteatoma.
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