Cholesteatoma Surgery: Residual and Recurrent Disease

Abstract

This is an analysis of 1,024 primary cases of mastoid surgery for cholesteatoma operated upon during a ten-year period at the Otologic Medical Group, Inc. Our philosophy of management of the mastoid in these cases has been as follows: 1) avoid an open mastoid cavity when possible; 2) perform the operation in two stages if necessary; 3) reexplore the mastoid and middle ear for residual cholesteatoma when indicated. One-third of 380 revised cases had residual cholesteatoma, disease left by the surgeon. In 260 cases in which the surgeon felt it unlikely that there was residual disease he found it in 23%. In 4% this residual cholesteatoma was found in the mastoid. The incidence of residual cholesteatoma was higher in children and in planned, as opposed to unplanned, revisions. Residual cholesteatoma was detected in the middle ear more frequently than in the epitympanum, and in the epitympanum more frequently than the mastoid. Indications for, and timing of, the reexploration are discussed. Recurrent cholesteatoma refers to a retraction pocket and must be differentiated from residual cholesteatoma; the causes, prevention and treatment are different. Recurrent cholesteatoma was detected in 5%. The most common complication of the disease was a labyrinthine fistula (10%). Operative facial nerve damage occurred in one case. The most common postoperative complication was graft failure (3%). Intact canal wall tympanoplasty with mastoidectomy should be performed as a two-stage procedure in most cases when used in the treatment of aural cholesteatoma.

Intact Canal Wall Tympanomastoid Surgery: 10 Years Experience

“…In our series, the frequency of residual and recurrent disease in 16 cases (5.8%) and thus considerably lower than the frequency observed in the classic CAT [12][13][14][15][16][17]. Removal of the disease from tympanic sinus is safer and easier via transcanal route after otosclerosis drilling of posterosuperior bony annulus.…”

“…Removal of disease from the anterior attic through the cortical mastoidectomy and from the tympanic sinus through the posterior tympanotomy is complicated, especially under narrow anatomical conditions and the large frequency of residual cholesteatoma is therefore not surprising [10][11][12][13][14][15][16][17][18].…”

“…Kinney [34] reported that the number of recurrences are reduced with attic obliteration by cartilage and perichondrium. Recurrent disease has occurred more frequently in classic ICW cases either due to retraction of tympanic membrane into the epitympanum and facial recess or due to reperforation of the tympanic membrane) [17]. Smyth [14] concluded that lack of support for the tympanic membrane graft, especially in its superior and postero superior parts, and the nearby meatal skin, predisposed to its collapse into the tympanum.…”

Treatment of Chronic Ear Infection with Polyposis - A Case Report

“…There is no doubt that in any case of cholesteatoma a surgery is the best option [2]. However, in the presence of polyposis of the middle ear disease, the surgery is not always a final resolution [1,2].…”

“…However, in the presence of polyposis of the middle ear disease, the surgery is not always a final resolution [1,2].…”