Autograft Ossiculoplasty in Cholesteatoma

Abstract

Although using autogenous ossicles in reconstruction offers stable hearing results with good tendency for healing and minimal extrusion, their use in cholesteatomatous ears has been criticized for the possibility of progressive osteitis, bone resorption and cholesteatoma recurrence. In the present study we have been investigating a way which affords safe re-implantation of such ossicles. Treatment by burring followed by autoclaving seems to offer an implant that is safe both bacteriologically and pathologically. We have found no evidence that cholesteatoma could develop from such treated ossicles.

Mechanical treatment and autoclaving of middle ear ossicles from cholesteatomatous ears

“…However, their use in patients with cholesteatoma has been limited by the risk of harbouring residual disease. The changes in the middle ear ossicles in cholestematous ears have been described in several histological studies [2][3][4][5][6][7][8][9][10]. However, the deeper invasion of cholesteatoma into the middle ear ossicles has never been published.…”

“…The three main methods of treating cholesteatoma residue from ossicles have been published [2][3][4]6,18]. These are microscopic stripping, burring over the ossicular surface, and autoclaving.…”

“…The risk of residual cholesteatoma after microscopic stripping is 6-64% [2,6]. This risk of residual disease could be reduced by burring of the ossicular surface [3,6] and increased in cases of badly eroded ossicles [2,6,18]. Available data of autoclaving of the middle ear ossicles have thus far been limited [3,4].…”

“…This risk of residual disease could be reduced by burring of the ossicular surface [3,6] and increased in cases of badly eroded ossicles [2,6,18]. Available data of autoclaving of the middle ear ossicles have thus far been limited [3,4]. The autoclaving of the ossicles provides safe autografts but the autoclaving protocol 20 min at 134°C is time-consuming and proof of its effectivity is limited [3,4].…”

“…However, their use in cholesteatoma ears has been limited by the possibility of harbouring within them residual cholesteatoma. There appears to be some evidence that the microscopic residuum of squamous cell epithelium in the ossicles could lead to reimplantation of the cholesteatoma [2][3][4][5][6][7][8][9][10]. The risk of cholesteatoma transmission using the autologous ossicles is widely accepted.…”