Surgical Technique and Recurrence in Cholesteatoma: A Meta-Analysis

Abstract

Conflicting reports and surgeon opinions have contributed to a long-standing debate regarding the merits of the intact canal wall versus canal wall down approach to cholesteatoma. The objective of this analysis was to identify and synthesize available data concerning rates of recidivism after the two primary types of cholesteatoma surgery. PubMed, Cochrane Collaboration, and Google Scholar searches were performed and articles filtered based on predetermined exclusion criteria. Individually reported rates of recurrent and residual disease were extracted and recorded. Meta-analysis demonstrated a relative risk of 2.87 with a confidence interval of 2.45–3.37, confirming a significantly increased incidence of postoperative cholesteatoma when using an intact canal wall approach rather than a canal wall down approach. Next, rates of recidivism following the typical two-stage intact canal wall operation were compared with a single-stage canal wall down operation and found to be similar. In conclusion, we advocate that greater consideration should be given to the canal wall down procedure in initial surgical management and identify the need for further exploration of rates of recidivism after staged or second-look procedures.

Increased Risk of Depression in Patients with Cholesteatoma: A 3-year Nationwide Population-Based Retrospective Cohort Study

“…Patients with problems associated with a post-operative cavity may also face the need for lifelong aural toilet, limitations in their exposure to water, caloric stimulation vertigo when cold air or water enters the cavity, delayed recovery, a cosmetically unpleasing appearance, or difficulties in fitting hearing aids [4]. The threat of recidivism (5-17% for canal wall down technique; 9-70% for canal wall up technique) [14] may also raise fears among patients regarding the need for repeated surgeries, which imposes an additional economic burden on patients [4]. Given the aforementioned difficulties, patients may become psychologically inhibited and socially withdrawn, such that DD would be a possible consequence of the physical impairments brought about by cholesteatoma.…”

Sinus Tympani y recidiva en cirugía de colesteatoma

“…En la literatura se ha reportado tasas de recidiva desde 20% a 70% en CWU, y 4% a 17% en CWD 11,12 . Una revisión de la literatura de resultados de cirugía endoscópica de colesteatoma evidenció una tasa de recurrencia de 9,3% de un total de 515 pacientes que fueron operados exclusivamente por vía endoscópica transcanal o con una técnica combinada.…”

Intercellular Communication between Keratinocytes and Fibroblasts Induces Local Osteoclast Differentiation: a Mechanism Underlying Cholesteatoma-Induced Bone Destruction

“…Complications of surgery, such as deafness, dizziness, and facial nerve palsy, can sometimes occur (65)(66)(67). Furthermore, it sometimes makes it difficult to identify recurrent or residual cholesteatoma (68,69). Preventing secondary infection by aspiration of debris makes cholesteatoma less aggressive and decreases complications; however, regular treatment is needed throughout life.…”