Middle ear endoscopes have been used, in place of the operative microscope, for management of deep retraction pockets with attic cholesteatoma. The procedure, as described by Tarabichi, is that of a transcanal atticotomy. Patients were carefully observed, on an outpatient basis, to assess for recurrence. Any disease with extensive mastoid involvement must be handled in traditional fashion. Episodic vertigo is the most debilitating symptom.
Many patients respond well to medical management, including diuretics and salt restriction.
Some patients, however, are refractory to treatment and require intervention for control of vertigo. The main diffusion route of gentamicin into the middle ear is through the round window membrane. Endoscopy performed before instillation of gentamicin can identify the obstruction. Any adhesions near the round window can be removed with variously angled hooks. Performing this maneuver may aid diffusion of gentamicin into the inner ear, thereby assisting treatment effectiveness.