Surgery for recurrent and residual cholesteatoma

Abstract

One hundred twelve patients (116 ears) were treated for recurrent and residual cholesteatoma. A retrospective review revealed that 66% had undergone canal wall down mastoidectomy at the previous surgery. The surgical procedure at revision was selected on the basis of an intraoperative assessment of the extent of disease, and clinical prediction of eustachian tube function. The average period of follow-up was 3.4 years. Revision surgery was successful in providing the patient with a safe, dry ear in 105 (91%) of 116 cases. Surgical principles and hearing results are presented.

Study on Causes and Management of Persistent Ear Discharge After Mastoidectomy for Cholesteatoma

“…The above results were comparable with various studies. (9,26) The results of healing in our cases with revision surgery and meatoplasty are consistent with Mills 27 where he stated that cavity revision above is likely to result in a dry ear in 57% of cases and while the combination of this approach with wide meatoplasty increases the success rate to 83%. According to Bhatia et al 14 and Tekin et al, 28 cavities are more likely to be dry, if they are not excessively large, having a low facial ridge, an adequate meatal opening and a closed middle ear space.…”

“…The important factors contributing to failure of primary surgery are suppuration in the mastoid cavity, may be due to residual disease in the tip, along the facial ridge, zygomatic cells, sinodural angle and cholesteatoma in regions easily overlooked during surgery such as sinus tympani, facial recess and anterior epitympanic recess. (9,13,14,15,16,17,18,19) The major sites of residual/recurrent disease contributing to discharging cavities at the time of revision mastoid surgery in our series were failure of meatoplasty and high facial ridge. The attic region which was the second most common site of residual cholesteatoma in our series, disease was found in anterior epitympanum anterior to head of malleus in patients having intact malleus and removal of malleus head was mandatory to remove the disease from this area.…”

“…In our study, the mean duration of recurrence of the disease was in the range of 3-5 years in 56% of patients. According to Simon C. Parisier & Mathew B Hanson, 9 generally residual cholesteatoma develop within 36 months after the initial procedure. Recurrent cholesteatoma may develop long after the initial surgery.…”

Endoscopic Anatomy of the Middle Ear

“…One is the potential persistence of disease inside the sinus due to incomplete removal and the second is the increased risk for ossicular discontinuity and hearing loss due to cholesteatoma within the ST [14,15], which the surgeon cannot control [16].…”

Immunohistochemical profile of various neurotransmitters, neurotrophins and MIB-1 in cholesteatomas of the petrous bone

“…Noteworthy, however, is the observation that the incidence of complications arising from cholesteatoma is directly related to the duration of the disease. Consequently, adults show higher complication rates (6).…”