Comparison of microscopic and 3D exoscopic canal wall down tympanomastoidectomy for primary middle ear cholesteatoma

Background The three-dimensional (3D) exoscope is an emerging alternative to the operating microscope (OM) in otologic surgery.Aims To assess its clinical utility in cholesteatoma surgery.Methods Retrospective review of 36 primary cases (21 OM, 15 exoscope) comparing setup time, surgical duration, audiological outcomes, and recurrence.Results Groups were comparable in background and stage. Setup time was shorter with exoscope (microscope: 20 min, range 18–22, exoscope: 17 min, range 14–20) (p = .002), while other outcomes showed no significant difference.Conclusions The 3D exoscope reduced setup time with equivalent surgical and functional outcomes to OM.