UC Irvine

Objective

To determine whether endoscopic cholesteatoma removal can be performed efficiently and safely using a curved fiberoptic-based laser.

Background

Angled instruments are required in endoscopic ear surgery to access recesses of the middle ear without extra drilling. Lasers are effective at ablating visible and microscopic cholesteatoma matrix and removing granulation tissue.

Study design

Retrospective case review from 2006 to 2013.

Setting

Single tertiary care center.

Patients

Patients who underwent cholesteatoma surgery with otoendoscopy.

Intervention

Residual cholesteatoma that could not be reached by conventional microinstruments was identified using an endoscope. This residual cholesteatoma was ablated in a contactless manner using a fiberoptic-based curved laser carrier with an argon laser. The laser tip through the carrier probe has a 45-degree curve, and the length of the tip is adjustable, allowing it to be used in recesses or around corners, such as in the sinus tympani, around the stapes suprastructure, in the oval window, or in the Eustachian tube orifice.

Main outcome measures

Presence or absence of residual cholesteatoma after laser ablation and complications.

Results

In 7 cases, the fiberoptic curved laser was used to ablate cholesteatoma completely with no injury to surrounding structures and with no evidence of recidivism with a mean follow-up period of 19 months. There were no cases of sensorineural hearing loss or perilymphatic fistula.

Conclusion

The curved laser probe allows for precise removal of cholesteatoma endoscopically.