Clinical analysis of secondary acquired cholesteatoma

Surgical management of secondary acquired cholesteatoma depends on its characteristics

OBJECTIVE

Cholesteatoma secondary to tympanic perforation, known as "secondary acquired cholesteatoma" may progress slower than a retraction pocket cholesteatoma, with less bone destruction and fewer intracranial complications. However, complete surgical removal remains difficult because the pathological epithelium on the marginal side of the extension is not covered by the subepithelial layer of the cholesteatoma matrix, making the boundary with the middle ear mucosa difficult to identify. Therefore, considering the pathophysiology of secondary acquired cholesteatoma, suitable preoperative evaluation and surgical techniques are required. In this study, we aimed to evaluate (i) the extension of secondary acquired cholesteatoma according to the size and location of tympanic membrane perforation; and (ii) the microscopic surgical outcomes, including the rate of residual cholesteatoma, requirement for specialized surgical management, and changes in hearing.

METHODS

This retrospective study included data of cases with secondary acquired cholesteatoma (n = 66; 66 ears of 64 patients, 2 patients had bilateral ear involvement), including those who underwent a staged operation (n = 25).

RESULTS

The perforation level of the tympanic membrane was associated with the cholesteatoma extension. When the cholesteatoma extended around the stapes, staged operation was chosen. Six cases of spontaneous resolution of stapes lesions at the time of staged surgery were observed. A significant postoperative improvement in hearing was observed; however, five cases experienced sensorineural hearing loss.

CONCLUSION

Surgery, including staged surgery of the stapes lesions, along with careful observation of the perforation, is required in secondary acquired cholesteatoma. For lesions that are visible yet challenging to remove, it is imperative to exercise prudent judgment, taking into account the possibility of spontaneous resolution.

Secondary Acquired Cholesteatoma: Presentation and Tympanoplasty Outcomes

OBJECTIVE

Comparing the clinical features and surgical outcomes of patients undergoing tympanoplasty for secondary acquired cholesteatoma (SAC) versus non-complicated tympanic membrane perforation (TMP).

STUDY DESIGN

Retrospective patient review.

SETTING

Tertiary-care, academic center.

PATIENTS

All 41 patients with diagnosis of SAC confirmed at surgery between January 1, 2007 and June 30, 2014, and an age-matched cohort consisting of patients with TMP.

INTERVENTION(S)

Tympanoplasty using either medial or lateral graft techniques.

MAIN OUTCOME MEASURE(S)

Resolution of perforation, SAC, and symptoms.

RESULTS

Comparison between the two cohorts failed to reveal significant differences in otologic symptomology, or presentation. There was no significant difference in the resolution of SAC (p = 0.7) between the medial and lateral tympanoplasty techniques. Both techniques also had similar rates of success in the TMP cohort. The medial graft technique was significantly (p = 0.008) more likely to result in a successfully repaired tympanic membrane in the TMP cohort compared with the SAC cohort. The Lateral graft technique demonstrated no significant difference in the likelihood of TMP and SAC resolution.

CONCLUSION

The presentation of SAC is similar to that of TMP despite being a separate clinical entity. A clinician's ability to distinguish the two is important to mitigate the destructive potential of untreated SAC and correctly council patients on tympanoplasty success rates. This study was unable to demonstrate a significant difference in disease control between the medial and lateral tympanoplasty techniques, although potential advantages of each technique are discussed.