Learning Objectives: To demonstrate that the endoscopic approach is a viable option when removing residual and recurrent cholesteatomas.

Introduction: While the endoscope has long been used in surgery, its adoption has been slower in ear surgery due to the narrowness, relative inaccessibility and delicateness of the ear. However, we have successfully used the endoscope in transcanal endoscopic ear surgery (TEES) as well as a combined transcanal-transcortical endoscopic approach. TEES is a less invasive procedure used initially to remove primary cholesteatomas located in the antrum and/or attic through the ear canal without the need for a large, invasive retroauricular incision. Moreover TEES can also now be used to remove residual and recurrent cholesteatomas if they are located in the attic and/or antrum. The combined transcanal-transcortical endoscopic approach is also being used to successfully remove recurrent cholesteatomas extending into the mastoid even after removal of the primary cholesteatoma via a transcortical mastoidectomy. Therefore the endoscopic approach should be considered as an option in the removal of residual and recurrent cholesteatomas regardless of their location.

Methods: The presence and location of residual and recurrent cholesteatomas were diagnosed by a CT scan and color mapped fusion imaging (CMFI). A CMFI was created by first combining a 1-mm thin slice non-EPI DWI with MR cisternography (MRC) and then performing color mapping to enhance the visualization of the cholesteatoma. TEES was used to remove cholesteatomas located in the attic and/or antrum. When the cholesteatoma extended into the mastoid, the dual transcanal-transcortical endoscopic approach was employed including a small retroauricular incision of less than 10 mm to insert the endoscope and other tools.

Results: We successfully removed residual cholesteatomas located in the attic and/or antrum and recurrent cholesteatomas extending into the mastoid using the endoscope.

Conclusion: The endoscopic approach is a viable option when removing residual and recurrent cholesteatomas regardless of their location.