Combined use of an operating microscope and a middle ear endoscope seems to be helpful for selecting an appropriate surgical technique and for identifying more patients in whom cholesteatoma can be removed by a trans-canal approach alone. To investigate whether attic cholesteatoma can be treated by a trans-canal approach alone, a review was performed of patients who had undergone endoscopically assisted tympanoplasty and the outcome of surgery was compared with the preoperative CT findings. Using a rigid endoscope (3 mm in diameter and 6 cm in length with a viewing angle of 30 degrees ), twenty eight patients were examined to determine whether total resection of the cholesteatoma was possible by trans-canal atticotomy alone. According to the CT findings, total resection of cholesteatoma was possible by trans-canal atticotomy combined with the use of a rigid endoscope not only in 4 patients with the shadow localized in the epitympanum on preoperative CT scans but also in 18 out of 24 patients with the shadow extending from the epitympanum to the distal mastoid air cells. This study indicates that the trans-canal approach with endoscopic guidance is a useful technique for the treatment of cholesteatoma.
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