Veetil Aswathi Kallyadan, Sarkar Saurav, Pradhan Pradeep, Karakkandy Vinusree, Nayak Anindya, Parida Pradipta Kumar, Chappity Preetam, Samal Dillip Kumar, Saravanan Aswini, Anil Abhishek
Department of ENT, and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India.
Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India.
Indian J Otolaryngol Head Neck Surg. 2025 Jun;77(6):2260-2270. doi: 10.1007/s12070-025-05466-9. Epub 2025 Apr 28.
Complete eradication of cholesteatoma and restoration of best possible hearing is the surgeons' goal for Chronic otitis media (COM) with cholesteatoma. For patients with chronic otitis media and cholesteatoma, the traditional surgical approach has been performed using a microscope. However, over the past 20 years, endoscopic ear surgery has evolved into a promising alternative technique. This study aimed to compare Completely endoscopic mastoid surgery (CEMS) to microscopic surgery in COM patients with cholesteatoma.This randomized controlled trial was conducted in a tertiary referral center from July 2019 to July 2021. Patients with squamous-type COM and cholesteatoma, meeting predefined inclusion criteria, were enrolled after block randomization. Endoscopic and microscopic mastoidectomies were performed in intervention and control groups respectively. The primary outcome was to compare the improvement in hearing, while secondary outcomes were duration of surgery, postoperative pain score, duration of hospital stay, recidivism rate during the study period, quality of life, and cosmesis.The study included 40 individuals with 20 patients in each group, and had well-matched demographics and disease characteristics. The mean pre-operative air conduction pure tone average reduced from 37.51 ± 5.41 dB to 30.62 ± 7.04 dB in the endoscopic group and from 43.46 ± 5.80 dB to 33.83 ± 5.99 dB in the microscopic group. Both groups yielded comparable post-operative hearing improvements, as well as no significant differences in surgical duration. However, CEMS demonstrated significantly lower postoperative pain scores (= 0.0002) and shorter hospital stays ( = 0.013). Quality of life scores improved significantly in the CEMS group postoperatively ( = 0.021), with higher patient satisfaction regarding cosmesis.Endoscopic ear surgery emerges as an excellent alternative to microscopic ear surgery for addressing the squamous type of chronic otitis media with cholesteatoma. It not only holds promise for improved hearing outcomes but also offers the benefits of reduced post-operative pain, shorter hospital stays, enhanced cosmesis, and better patient satisfaction.
The online version contains supplementary material available at 10.1007/s12070-025-05466-9.
彻底清除胆脂瘤并尽可能恢复最佳听力是外科医生治疗慢性化脓性中耳炎（COM）伴胆脂瘤的目标。对于慢性化脓性中耳炎伴胆脂瘤患者，传统的手术方法是使用显微镜进行。然而，在过去20年中，耳内镜手术已发展成为一种有前景的替代技术。本研究旨在比较完全耳内镜乳突手术（CEMS）与显微镜手术治疗COM伴胆脂瘤患者的效果。
这项随机对照试验于2019年7月至2021年7月在一家三级转诊中心进行。符合预定纳入标准的鳞状型COM和胆脂瘤患者在区组随机化后入组。干预组和对照组分别进行内镜下和显微镜下乳突切除术。主要结果是比较听力改善情况，次要结果包括手术时间、术后疼痛评分、住院时间、研究期间的复发率、生活质量和美容效果。
该研究纳入了40名个体，每组20名患者，两组的人口统计学和疾病特征匹配良好。内镜组术前气导纯音平均听阈从37.51±5.41dB降至30.62±7.04dB，显微镜组从43.46±5.80dB降至33.83±5.99dB。两组术后听力改善情况相当，手术时间也无显著差异。然而，CEMS术后疼痛评分显著更低（=0.0002），住院时间更短（=0.013）。CEMS组术后生活质量评分显著提高（=0.021），患者对美容效果的满意度更高。
对于治疗鳞状型慢性化脓性中耳炎伴胆脂瘤，耳内镜手术是显微镜耳手术的一种极佳替代方法。它不仅有望改善听力结果，还具有术后疼痛减轻、住院时间缩短、美容效果增强和患者满意度更高的优点。
在线版本包含可在10.1007/s12070-025-05466-9获取的补充材料。
