Transcanal endoscopic management of cholesteatoma in children

Research Objectives. The aim of this study was to evaluate the effectiveness of an endoscopic approach in the surgical treatment of chronic suppurative otitis media (CSOM) with cholesteatoma in children. Material and methods. Between 2021 and 2025, 65 endoscopic surgeries were performed at the Federal Scientific and Clinical Center for Children and Adolescents of FMBA on children with chronic suppurative otitis media and confirmed cholesteatoma. The patients’ age ranged from 2 to 17 years (mean age 6.6 years). The follow-up period ranged from 3 to 39 months. The study included patients with CSOM and cholesteatoma without signs of the pathological process spreading into the mastoid cells. The standard surgical technique involved a transcanal approach, creation of a meato-tympanic flap, and sequential removal of the cholesteatoma under the control of 0° and 45° Karl Storz rigid endoscopic optics. All patients underwent not only the debridement but also a reconstructive stage of the surgery using a chondro-perichondrial tragal graft. Treatment effectiveness was assessed based on the integrity and vascularization of the neotympanic membrane, as well as the absence of signs of residual cholesteatoma or its recurrence, using control studies (CT and MRI fusion imaging) at 6 and 12 months postoperatively. Results. All patients in the postoperative period showed satisfactory vascularization of the neotympanic membrane, with no signs of lateralization or deformation of the cartilage graft. During the follow-up, no signs of residual or recurrent cholesteatoma were detected based on postoperative examinations. The only intraoperative complication was injury to the jugular bulb in one patient; the bleeding was stopped intraoperatively with local packing, and the surgery was completed in full. Conclusion. The isolated endoscopic transcanal approach is an effective and minimally invasive technique for the treatment of chronic suppurative otitis media. The endoscopic approach provides optimal visualization of hardto- reach areas of the middle ear that are inaccessible without additional bone removal when using a microscope. The ability to «look around the corner» using angled optics allows for the precise removal of residual cholesteatoma tissue, thereby preventing further interventions. Furthermore, the endoscopic approach is associated with less surgical trauma and less postoperative pain, which is particularly important in pediatric practice. However, the isolated endoscopic approach is not universal and has limitations, primarily related to anatomical features or the spread of cholesteatoma into the mastoid process — in such cases, a combined approach is preferable. Endoscopic assistance is advisable for any scope of intervention in all cases, as it significantly increases the thoroughness of debridement and reduces the risk of recurrence.
Keywords: cholesteatoma, endoscopic otosurgery, chronic suppurative otitis media, endoscopy
Conflict of interest. The authors have no conflicts of interest.
Funding. Absent.