Feasibility of piezosurgery in management of cholesteatoma with retrotympanic extension

Abstract Background : The application of piezoelectric technology in the otology field has gained traction recently, showcasing its ability to cut bone precisely without damaging the nearby soft tissue. The study aimed to determine the safety and efficacy of using a piezoelectric device in canal wall up mastoidectomy via a facial recess approach to eradicate middle ear cholesteatoma extending into the retrotympanic space. Patient and Methods: A prospective cohort study conducted among 31 consecutive patients with middle ear cholesteatoma extending into retrotymanic spaces proved clinically and radiologically at our tertiary referral center in the period between February 2024 and January 2026. Post-operative complication (Facial nerve palsy, taste sensation, vertigo and SNHL), pain by visual analog scale (VAS; 0–10) and pure-tone audiometry in the follow up were recorded. Result : Complete eradication of cholesteatoma reported in 29 patients (93.55%) after a follow up period of 17±4.16 months. Statistically significant improvement in AC and ABG postoperatively (p-value <0.001),while BC thresholds showed no significant difference (No SNHL),none of the patients developed facial nerve, or wound dehiscence, or vertigo injuries despite the presence of 3 patients (9.7%) with facial canal dehiscence .None of the patients experienced pain after 1 week post operatively. Conclusion : Piezosurgery paired with a microdrill and microscope is yielding hopeful and promising outcomes in managing cholesteatoma that has spread to the retrotympanic region.