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Expert Lectures

Otology/Neurotology

Cholesteatoma: Surgical Decision Making with Special Emphasis on Approach and Visualization

Monday, October 13, 2025
2:30 PM - 3:30 PM EDT
Location: 244
Disclosure(s):
Zachary G. Schwam, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Eric E. Smouha, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

PROGRAM DESCRIPTION: Cholesteatoma is a surgical disease, the approach to which is determined by involved structures, the anatomy of the middle ear and mastoid, and the presence of complications (labyrinthitis, intracranial extension). The endoscope has distinct advantages in temporal bone surgery for appropriately selected patients (improved visualization, avoidance of postauricular incision, ability to see around corners) but also has technical limitations (monocular vision, one- handed surgery) and therefore has not gained universal acceptance.

In this lecture, two otologists with high volume surgical practices will discuss decision making as it applies to surgical approach (transmeatal vs. postauricular, open vs. closed cavity mastoidectomy, and primary vs. delayed ossicular chain reconstruction). The advantages and limitations of endoscopic and microscopic approaches will be illustrated using surgical videos. A hybrid endoscope-assisted technique will also be presented that combines the best features of each.

Cholesteatoma surgery must be individualized to the specific findings in each case. We will discuss the use of preoperative imaging and how it informs real-time intraoperative surgical decision making. Our goal in this lecture is to present a variety of cases using surgical videos highlighting decision making as it relates to techniques and approaches that will yield optimal management strategies. We plan to present a range of cases to accommodate an audience with varying levels of experience.

OUTCOME OBJECTIVE 1: Examine the principles of cholesteatoma management and apply these principles to surgical approach and methodology.

OUTCOME OBJECTIVE 2: Recognize the strengths and limitations of the endoscope in middle ear surgery.

OUTCOME OBJECTIVE 3: Explain how technical decisions can affect surgical outcomes and disease recurrence.

BACKGROUND STATEMENT: Cholesteatoma is a common pathology treated by otologists and comprehensive otolaryngologists alike. Due to variables in surgical management and increased utility of the endoscope in temporal bone surgery, a review of surgical approaches and decision making is appropriate.

Comprehensive Otolaryngology Track Statement :

    Co-Presenter(s)

  • Zachary G. Schwam, MD

    Assistant Professor
    Icahn School of Medicine at Mount Sinai
    New York, NY, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Lead Presenter(s)

  • Eric E. Smouha, MD

    Clinical professor of otolaryngology, Icahn school of Medicine at Mount Sinai
    ENT and Allergy Associates
    New York, NY, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.