الفهرس 
Introduction and aim of the work
Controversy in cholesteatoma surgeryOnly 14 pages are availabe for public view
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Abstract
Objectives: Otoendoscopy has shown to be a safe and effective tool that is complementary to otomicroscopy in primary cholesteatoma surgery. This study was undertaken to review the intraoperative role of endoscopes to facilitate and ensure successful cholesteatoma eradication. Also to study the ability of otoendoscopic techniques to alleviate the longlasting controversy about the ideal approach for cholesteatoma surgery. Methods: 358 acquired cholesteatoma cases were included in this study. They were divided into two groups. First group cases (170 closed technique cases and 84 open technique cases) were operated upon without perioperative aid of the otoendoscopes. Second group cases (87 closed technique cases and 27 open technique cases) included all patients operated upon with the incorporation of otoendoscopic guidance as a principal part of the procedure. Role of endoscopes was to detect and verify complete ablation of an epidermic remnant in areas that are difficult to visualize with the operative microscope. Endoscopes with various observation angles were introduced either transcanal or transmastoid. Both groups were followedup for at least two years. Results: Intraoperative residue was detected in 31% of the cases operated upon by the closed technique and 22% of cases approached by the open technique due to the incorporation of endoscopic assistance to the procedure. Sinus tympani was the most common site of intraoperative residuals (64%). On the two years followup period 33% of first group closed technique cases and 11% of the same group open technique cases showed residual cholesteatoma. While 6% of second group closed technique cases and 4% of the same group open technique cases showed residual cholesteatoma. Sinus tympani still the most common site for the residual disease (38%). Conclusions: Rigid endoscopy in conjunction with conventional otomicroscopy provides improved visualization of hardtoreach areas and the potential for more complete removal of the disease. Although middle ear endoscopy incorporation with closed techniques does not obviate the need for a planned exploratory surgery or at times open techniques, the rate of residual disease should significantly decrease as experience with this technique is gained and with more improvement of scopes and instruments.