title: Extension of indications for transcanal endoscopic ear surgery using an ultrasonic bone curette for cholesteatomas.
abstract: BACKGROUND
  One-handed endoscopic procedures have, up until now, limited the indications for transcanal endoscopic ear surgery (TEES) in cholesteatoma surgery. However, the development of electrically powered instruments has opened the door to such one-handed endoscopic procedures in restricted surgical spaces.
  
  
  OBJECTIVE
  We examined the feasibility of using one such powered instrument, the ultrasonic bone curette (UBC) in TEES for cholesteatoma surgery. The UBC offers several advantages, including nonrotational motion and the combination of both suction and irrigation in a single handpiece.
  
  
  METHODS
  A prospective case series.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  TEES was performed on 43 cases of primary cholesteatoma between September 2011 and December 2012, including 14 cases extending to the antrum.
  
  
  METHODS
  Zero-, 30-, or 70-degree angled rigid endoscopes with an outer diameter of 2.7 mm (Karl Storz) were used together with a high-definition video system. A Sonopet UBC (Stryker) was used to cut bony tissue. The nonrotational motion of the UBC prevents injury to the tympanomeatal flap and other soft tissue, which may result with standard drills. Transcanal endoscopic retrograde mastoidectomy on demand was performed to access the pathologies in the attic and antrum.
  
  
  RESULTS
  A minimum attico-antrotomy was performed using the UBC, removing only the bony tissue necessary to visualize the pathology. The cholesteatoma was completely removed from the antral mucosa under clear endoscopic visualization in 13 of 14 cases. After removal of the cholesteatoma, the canal wall was reconstructed using cartilage taken from the tragus. This procedure resulted in greater mastoid preservation.
  
  
  CONCLUSIONS
  The transcanal endoscopic approach to the antrum using the UBC proved to be less invasive and more functional. The UBC contains both a suction and irrigation system in a single handpiece, and this UBC is an appropriate cutting tool that extends the indications for TEES.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Kakehata
authors.forename: Tomoo
authors.initials: T
authors.lastname: Watanabe
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Ito
authors.forename: Toshinori
authors.initials: T
authors.lastname: Kubota
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Furukawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000473:pathology / Q000601:surgery*; D004424:Ear Canal / Q000473:pathology / Q000601:surgery*; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013506:Otologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult