Combined use of an operating microscope and a middle ear endoscopeseems to be helpful for selecting an appropriate surgicaltechnique and for identifying more patients in whom cholesteatomacan be removed by a trans-canal approach alone. To investigatewhether attic cholesteatoma can be treated by a trans-canalapproach alone, a review was performed of patients who hadundergone endoscopically assisted tympanoplasty and the outcome ofsurgery was compared with the preoperative CT findings. Using arigid endoscope (3 mm in diameter and 6 cm in length with aviewing angle of 30°), twenty eight patients were examined todetermine whether total resection of the cholesteatoma waspossible by trans-canal atticotomy alone. According to the CTfindings, total resection of cholesteatoma was possible bytrans-canal atticotomy combined with the use of a rigid endoscopenot only in 4 patients with the shadow localized in theepitympanum on preoperative CT scans but also in 18 out of 24patients with the shadow extending from the epitympanum to thedistal mastoid air cells. This study indicates that thetrans-canal approach with endoscopic guidance is a usefultechnique for the treatment of cholesteatoma.
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