Vol.:(0123456789) 1 3 European Archives of Oto-Rhino-Laryngology https://doi.org/10.1007/s00405-019-05588-1 OTOLOGY Trans‑canal endoscopic ear surgery and canal wall‑up tympano‑mastoidectomy for pediatric middle ear cholesteatoma Eran Glikson 1,2  · Gilad Feinmesser 1  · Doron Sagiv 1  · Michael Wolf 1,2  · Lela Migirov 2  · Yisgav Shapira 1,2 Received: 17 May 2019 / Accepted: 29 July 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Purpose To evaluate clinical parameters, outcomes and complications of transcanal endoscopic ear surgeries (EES) and canal wall-up tympano-mastoidectomy (CWU) for middle ear cholesteatoma in children and to compare between the two surgical approaches. Methods A retrospective chart review of all children (< 16 years) who underwent surgery for cholesteatoma involving the middle ear only with a minimal follow-up period of 12 months. Demographic features, site and extent of disease, outcome and complications were reviewed and compared between the groups. Results Thirty EES and 19 CWU were included. The overall disease relapse rates in the EES and CWU groups were 20% (n = 6, residual rate = 10%, recurrence rate = 10%) and 47% (n = 9, residual rate = 11%, recurrence rate = 37%), respectively (p = 0.04), with mean duration of follow-up of 32.6 and 37.2 months, respectively. In the EES and CWU groups, the most common site of residual disease was the mastoid cavity/antrum (n = 2, 66% and n = 2, 100%, respectively). Most recurrences involved the epitympanum and extended into the tympanic cavity (n = 2, 66%) in the EES group and into the tympanic cavity, posterior mesotympanum and mastoid cavity/antrum (n = 3, 43%, each) in the CWU group. The overall complication rates in the EES and CWU groups were 10% (n = 3) and 11% (n = 2), respectively (p = 0.61). Conclusions Endoscopic ear surgeries in children were found to be an acceptable and safe technique for the treatment of cholesteatoma limited to the middle ear cavity. A better overall success rate and a similar complication rate were found in the EES group when compared to CWU. Keywords Cholesteatoma · Endoscopic ear surgery · Pediatric · Canal wall up · Mastoidectomy Introduction The annual incidence of cholesteatoma in pediatric patients is reported to be 3–6 per 100,000 [1]. Cholesteatoma in chil- dren is more aggressive and has a higher recurrence rate as compared to adults [2]. The greater degree of upper airway infections, and otitis media caused by Eustachian tube dys- function, is probably promoting factors for cholesteatoma development in the pediatric population. Surgical management of pediatric cholesteatoma is cur- rently controversial. Traditional treatment options include canal wall-down (CWD) or canal wall-up (CWU) tympano- mastoidectomy. The overall reported rates of residual cho- lesteatoma in all age groups reach 7% (range 2–21%) and 22% (range 15–27%) for CWD and CWU mastoidectomies, respectively, and the recurrence rates reach 5% (range 0–10%) and 25% (range 9–70%), respectively [3–6]. Previ- ous reports suggest an increased incidence of residual dis- ease in children (up to 51%) [1, 2]. Since operative endoscopy was introduced into ear sur- gery, it has signifcantly changed surgical, anatomic and physiologic concepts [7]. The endoscopes provide better visualization of common sites of residual cholesteatoma and may, therefore, decrease residual disease, enabling preservation of the ear canal wall. Transcanal endoscopic tympano-atticotomy (EES) is indicated for cholesteatoma confned to the tympanic cavity and attic without involving the mastoid [8]. * Eran Glikson Eran.Glikson@sheba.health.gov.il 1 Department of Otolaryngology, Head and Neck Surgery, Sheba Medical Center, 5262100 Tel-Hashomer, Israel 2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel