Endoscopic Versus Microscopic Management of Attic Cholesteatoma: A Randomized Controlled Trial

ObjectivesTo compare endoscopic transcanal approach to attic cholesteatoma with conventional microscopic transcanal technique MethodsSeventy-eight patients diagnosed with attic cholesteatoma were randomly assigned into two groups-one undergoing endoscopic approach and the other microscopic technique. The two groups were compared in terms of area of exposure, access to hidden areas in terms of Middle Ear Structural Visibility Index (MESVI), intraoperative time, postoperative pain, vertigo, long-term hearing, and surgical outcomes. ResultsThe mean area of exposure in endoscopic atticotomy required was less than that in microscopic group and was found to be statistically significant. The median MESVI for endoscopic group better than that for microscopic group (P<.0001). The mean operating time in endoscopic approach was less than that in case of microscopic approach, with P<.05. The median postoperative pain score in the endoscopic group was less than that in microscopic group (P<.05). No significant difference was found between two groups in terms of vertigo experienced at the end of first week and air-bone gap closure. When long-term surgical outcomes were assessed at 1 year, in endoscopic group, one patient had disease recurrence, one cartilage displacement, one perforation, and two had retraction pocket formation. In the microscopic group, two patients had recurrence, four cartilage displacement, one perforation, and five retraction pocket formation. ConclusionEndoscopic management of limited attic cholesteatoma has definite advantages over the conventional microscopic approach. Level of Evidence1 Laryngoscope, 2019