Use of the ORBEYE™ Exoscope for the Treatment of Presumed Postoperative Cholesteatoma of the External Auditory Canal: A Case Report

Background/Objectives: To describe the technical feasibility of fully exoscopic management of an unusually extensive external auditory canal cholesteatoma (EACC). Methods: We report a 26-year-old man with advanced right EACC and a history of ipsilateral myringoplasty approximately 15 years previously; a postoperative origin was suspected but could not be established. Clinical, radiological, surgical, and follow-up findings are described. Results: Imaging revealed extensive erosion of the superior EAC and adjacent temporal bone with mass effect on the right temporal lobe. The ORBEYE™ 4K three-dimensional exoscope was used throughout the operation, including dissection along exposed dura and hearing-preserving reconstruction. An intraoperative cerebrospinal fluid leak occurred at the middle cranial fossa dura and was controlled during surgery, without persistent postoperative leakage. The patient was discharged on postoperative day 4. Based on the reported four-frequency pure-tone averages, the calculated air–bone gap decreased from 18.5 to 8.5 dB HL. Diffusion-weighted MRI at 18 months showed no evidence of residual or recurrent disease, and clinical examination at 24 months showed a patent, epithelialized canal. Conclusions: This case illustrates the technical feasibility of a fully exoscopic, hearing-preserving approach to complex EACC. Comparative studies are required before conclusions about superiority or generalizable safety relative to conventional visualization can be drawn.