Endoscopic laser-assisted approach to benign middle-ear tumors: single-center case series

Introduction The transcanal endoscopic approach to benign middle-ear tumors allows a minimally invasive surgery, though it can be challenging. In this scenario, the laser may provide improved coagulation and vaporization, thus minimizing bleeding and trauma to the ossicular chain. The aim of this study was to report a single-center experience in the endoscopic laser-assisted approach to benign middle-ear tumors. Methods A retrospective case series of patients who underwent exclusive transcanal endoscopic carbon dioxide (CO 2 ) or blue light (BL) laser-assisted surgery for early-stage benign middle-ear tumors between June 2018 and August 2026 was performed in a third-level, adult, university hospital. The present study expands upon a previously published case series. Results Fifteen patients met the inclusion criteria. One case required a retroauricular incision (combined approach) and 14 cases successfully completed exclusive transcanal endoscopic excision (conversion rate 1/15, 6.7%). Out of these 14 cases, 12 patients (85.7%) were women with a mean age of 62.5 years (SD, 12.6). There were 13 glomus tympanicum (GTT) and one middle-ear adenomatous neuroendocrine tumor (MEANT). Eight GTTs were treated using a CO 2 laser and six cases (five glomus and one MEANT) using a BL laser. Mean surgical duration and hospitalization time were 150 min (range 90–230) and 9.1 h (SD, 5.9), respectively. Mean tumor size was 5.1 mm (SD, 2.1). The mean follow-up period was 43.6 months (range 3–98), with one case (7.1%) having tumor recurrence (B1 tumor). Four patients had tympanic membrane perforations repaired intraoperatively (cartilage palisade) and one patient needed myringoplasty on follow-up. Otherwise, there were no substantial postoperative complications. Mean pure-tone average improved by 5.9 dB (SD, 7.4) after surgery. This improvement was clinically limited (<10 dB). Discussion The findings in the present study support the feasibility of endoscopic laser surgery as a minimally invasive technique for treating early-stage benign middle-ear tumors, and demonstrate favorable short- to intermediate-term clinical outcomes.