This study aimed to develop a novel surgery classification for an endoscopic approach to
middle ear cholesteatoma. We retrospectively analyzed the surgical approaches and outcomes of patients with
middle ear cholesteatoma.
Middle ear cholesteatoma surgeries were divided into four types and two special types as follows: type I, attic retraction pocket, which only requires
tympanostomy tube placement or retraction pocket resection and cartilage reconstruction; type II,
cholesteatoma which is limited to the attic or in which endoscopy can confirm complete removal of mastoid
cholesteatoma lesions, including type II a, requiring only use of a curette, and type II b, requiring use of an electric drill or chisel; type III,
cholesteatoma not limited to the attic, in which endoscopy cannot confirm complete removal of mastoid
cholesteatoma lesions, requiring the combined use of
endoscope and microscope to perform endoscopic
tympanoplasty and "Canal Wall Up"
mastoidectomy; type IV, extensive involvement of mastoid cavity
cholesteatoma lesions and/or cases with a potential risk of complications, removal of which can only be performed under a microscope for "Canal Wall Down"
mastoidectomy. In addition, there were two special types: "difficult external auditory canal" and
congenital cholesteatoma in children. In our system, type I and type II
middle ear cholesteatoma surgery was completely performed under an
endoscope alone. However, estimating the extent of the lesions, determining the choice of mastoid opening and reestablishing ventilation are the key points for an endoscopic approach to
middle ear cholesteatoma. The classification of endoscopic
middle ear cholesteatoma surgery may benefit the selection of surgical indications.