BACKGROUND: Cholesteatoma of the external auditory canal (EACC) is a destructive lesion requiring endoscopic surgical resection, but intraoperative lens contamination and postoperative epithelialization delays remain challenges. The rationale for this study was to investigate whether a novel continuous irrigation system could optimize surgical visibility, reduce procedural burdens, and improve postoperative outcomes in EACC management.

MATERIAL AND METHODS: A retrospective comparative cohort study of 66 patients undergoing surgery for EACC at Shenzhen Nanshan People’s Hospital (January 2022 to December 2024) was conducted. Patients were randomly assigned to 2 groups of 33 patients each: the continuous irrigation mode (experimental) group and the non-irrigation mode (control) group. Key outcome measures included intraoperative lens-cleaning frequency, operation duration, postoperative complications, epithelialization time (defined as the external auditory canal having no exudate and the granulation tissue on its surface being covered by normal skin tissue), hearing outcomes, cleaning frequency within 6 months, and recurrence rate of external auditory canal cholesteatoma.

RESULTS: The experimental group demonstrated shorter operation time, fewer lens cleanings, reduced complication rates, faster epithelialization, and lower postoperative cleaning frequency (P<0.05). hearing outcomes and recurrence rates were comparable between groups (P>0.05).

CONCLUSIONS: Continuous irrigation during endoscopic EACC surgery improves surgical efficiency by reducing lens contamination and operation time, while enhancing postoperative recovery through fewer complications and faster epithelialization. These findings support its clinical utility, particularly in settings with limited resources. However, multi-center prospective studies are warranted to confirm long-term efficacy and safety.

Keywords: Cholesteatoma, endoscopic mucosal resection, Humans, Ear Canal, Female, Male, Therapeutic Irrigation, adult, Retrospective Studies, endoscopy, Middle Aged, Treatment Outcome, Otologic Surgical Procedures, Postoperative Complications, operative time