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Mammarella F, Loperfido A, Cianciulli M, Fionda B, Stasolla A, Bellocchi G. External Auditory Canal Cholesteatoma after Radiation Therapy for Nasopharyngeal Cancer: Case Series and Systematic Review. J Clin Med 2023; 12:jcm12051977. [PMID: 36902764 PMCID: PMC10004166 DOI: 10.3390/jcm12051977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/20/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
The authors performed a systematic review, in accordance with the PRISMA guidelines, across multiple databases, including all original studies published until November 2022, focusing on External auditory canal cholesteatoma (EACC) after radiation therapy (RT) for nasopharyngeal cancer (NC). Inclusion criteria were original articles reporting on secondary EACC after RT for NC. Articles were critically appraised to assess level of evidence using the Oxford Center for Evidence-Based Medicine criteria. Overall, 138 papers were identified and after duplicate removal (34 papers) and excluding papers not in English, 93 papers were assessed for eligibility; finally, only five papers were included and summarized with the three cases coming from our institution. These mainly involved the anterior and the inferior part of the EAC. The mean time of diagnosis after RT was the largest series of 6.5 years (with a range from 0.5 to 15.4 years). Patients undergoing RT for NC have 18 times a higher risk of developing EACC compared to the normal population. EACC is probably one of the most underreported side effects, because patients may present variable clinical findings, which could lead to misdiagnosis. Early diagnosis of RT related EACC is advised to enable conservative treatment.
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Affiliation(s)
- Fulvio Mammarella
- Otolaryngology Unit, San Camillo Forlanini Hospital, 00152 Rome, Italy
| | | | - Michele Cianciulli
- Department of Radiation Oncology, San Camillo Forlanini Hospital, 00152 Rome, Italy
| | - Bruno Fionda
- U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Correspondence:
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Matosevic L, Friedrich H, Negoias S, Dür C, Caversaccio M, Dubach P. Taste Alteration in External Auditory Canal Cholesteatoma: Indicator of Impending N VII Affection. ORL J Otorhinolaryngol Relat Spec 2023; 85:177-185. [PMID: 36634634 DOI: 10.1159/000527886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 10/26/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION External auditory canal cholesteatoma (EACC) is a rare disease, with an estimated incidence of approximately 1:1,000 adult and 1.6:1,000 pediatric otologic patients. Systematic studies of chronic ear disease and taste alteration prior to surgery are rare; in fact, there are no such studies for EACCs. Therefore, we describe chorda tympani nerve (CTN) dysfunction and the related clinical consequences in EACC patients. METHODS/STUDY DESIGN Between 1992 and 2021, we retrospectively analyzed the symptoms, signs, and radiological and intraoperative descriptions of CTN involvement in 73 patients. Liquid taste tests and, since 2009, Taste StripsTM as well as an olfactory screening test (Smell DiskettesTM) have been performed for all symptomatic patients and, when feasible, all other EACC patients. LEVEL OF EVIDENCE: 4 RESULTS Ten of 73 patients complained subjectively of dysfunction, and 8 showed abnormal taste test results. Four patients complained of olfactory dysfunction (3 cases with pathological taste tests). Gustatory dysfunction was most frequent in radiogenic EACC cases (n = 4), followed by postoperative EACC (n = 3). Two postoperative patients were asymptomatic despite abnormal test results. Rarely, patients with idiopathic (n = 2) and posttraumatic (n = 1) EACC showed acute taste dysfunction that was confirmed in each with abnormal test results. DISCUSSION/CONCLUSION CTN dysfunction often developed asymptomatically in chronic ears, except for idiopathic and posttraumatic EACCs under previous healthy middle ear conditions. Taste disturbance is not a cardinal symptom of EACC, but objective testing suggests that up to one out of 10 EACC patients with advanced disease may experience regional gustatory dysfunction prior to surgery. Especially in context of a new and acute presentation, regional taste dysfunction may alert the clinician of potential progressive EACC invasion and danger to the facial nerve.
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Affiliation(s)
- Lilia Matosevic
- ENT Department, Burgerspital Solothurn, Solothurn, Switzerland
| | | | - Simona Negoias
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Basel, Basel, Switzerland
| | - Cilgia Dür
- Department of ENT, Head and Neck Surgery, Inselspital Bern, University Hospital, Bern, Switzerland
| | - Marco Caversaccio
- Department of ENT, Head and Neck Surgery, Inselspital Bern, University Hospital, Bern, Switzerland
| | - Patrick Dubach
- ENT Department, Burgerspital Solothurn, Solothurn, Switzerland
- Department of ENT, Head and Neck Surgery, Inselspital Bern, University Hospital, Bern, Switzerland
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Cholesteatoma of the External Auditory Canal: Review of Staging and Surgical Strategy. Otol Neurotol 2019; 39:e1026-e1033. [PMID: 30212428 DOI: 10.1097/mao.0000000000001972] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION External auditory canal cholesteatomas (EACC) is insidious in nature and rare entity. There are only few case series on EACCs and surgical strategy is not standardized. OBJECTIVES 1) To elucidate etiology of EACC and cardinal features. 2) To suggest a practical staging of EACC. 3) To enumerate surgical management according to stage of EACC. STUDY DESIGN Retrospective study in a quaternary referral center of 31 consecutive cases of EACC. RESULTS Thirty-one patients with EACC were reviewed. Unilateral otorrhea 19 (61.2%), hearing loss 22 (70.9%), and otalgia 8 (25.8%) are cardinal symptoms. Sixteen primary and 15 secondary EACCs were treated. Bone erosion was observed in 20 cases. In the present series, stage III = 12 (38.7%), stage II = 8 (25.8%), stage I = 11 (35.4%) underwent definitive treatment by surgery. Canalplasty with reconstruction was done in 19 cases of stages I and II. Of 12 cases in stage III, 3 cases underwent canalplasty with reconstruction. Subtotal petrosectomy was done in five cases. Intact canal wall mastoidectomy with canalplasty in two cases and radical mastoidectomy in two cases. Fascia, cartilage, muscle, and bone dust were used for reconstruction. Median follow-up period was 6 years and no recurrence of cholesteatoma was observed. CONCLUSION EACC is unique entity. Intraoperative and radiological findings assist in correct and practical staging of EACC. Late stage presentations of EACC are common. Definitive surgical treatment in our series avoided recurrence of cholesteatoma.
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Clinical Characteristics and Treatment Outcomes for Patients With External Auditory Canal Cholesteatoma. Otol Neurotol 2019; 39:189-195. [PMID: 29210949 DOI: 10.1097/mao.0000000000001659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We aimed to evaluate the clinical features and treatment outcomes for patients with idiopathic and secondary external auditory canal cholesteatoma (EACC), and to validate the treatment strategy from the perspective of hearing as well as etiology and staging. STUDY DESIGN Retrospective case series. SETTING Tertiary referral center and affiliated hospitals. PATIENTS Fifty-eight patients with idiopathic EACC and 14 patients with secondary EACC. INTERVENTION Conservative management and surgery. MAIN OUTCOME MEASURE Air conduction (AC) pure-tone averages (PTAs) and mean air-bone gaps (ABGs). RESULTS There were no significant differences between hearing values before and after conservative management for idiopathic EACC patients with stages I-III, indicating that hearing abilities were preserved. For idiopathic EACC patients with stage IV disease treated with surgery, the AC PTA threshold and mean ABG significantly improved from a preoperative value of 60.3 dB HL to a postoperative value of 32.4 dB HL (p = 0.013), and from 34.3 to 9.5 dB HL (p < 0.001), respectively. For secondary EACC, the AC PTA threshold and mean ABG significantly improved from a preoperative value of 49.5 dB HL to a postoperative value of 23.2 dB HL (p < 0.001), and from 31.4 to 6.7 dB HL (p < 0.001), respectively. CONCLUSION The treatment modalities should be selected based on the perspective of hearing as well as the extent of disease and etiology. The early lesions can be treated conservatively, whereas the advanced lesions or cases refractory to conservative management require complete surgical removal of EACC.
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External auditory canal cholesteatoma and benign necrotising otitis externa: clinical study of 95 cases in the Capital Region of Denmark. The Journal of Laryngology & Otology 2018; 132:514-518. [PMID: 29888691 DOI: 10.1017/s0022215118000750] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify epidemiological and pathophysiological factors, and treatment strategies, in external auditory canal cholesteatoma and benign necrotising otitis externa. METHODS A retrospective case study was conducted of patients suffering from external auditory canal cholesteatoma and benign necrotising otitis externa admitted to tertiary hospitals, in the Capital Region of Denmark, over a five-year period. RESULTS Eighty-three patients (95 ears) with external auditory canal cholesteatoma or benign necrotising otitis externa were identified. A minimum incidence rate of 0.97 per 100 000 inhabitants per year was demonstrated. Sixty-eight per cent of cases had a history of smoking. Most lesions (74 per cent) were localised in the floor of the ear canal. Treatment time was 3.2 months for patients who had surgery and 6.0 months for those who received conservative treatment. CONCLUSION It is suggested that external auditory canal cholesteatoma and benign necrotising otitis externa are in fact the same disease, and therefore the diagnosis of external auditory canal cholesteatoma should be changed to benign necrotising otitis externa. Microangiopathy has a leading role in the aetiology. Surgery should be conducted in most cases.
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Abstract
BACKGROUND Treatment of external auditory canal cholesteatoma (EACC) has been a question of debate. To our knowledge and according to a systematic review of endoscopic ear surgery (EES) in 2015, this study describes for the first time the technique and outcome by solely transcanal EES for EACC. STUDY METHOD Retrospective case series, level of evidence IV. METHODS Between October 2014 and December 2016, nine patients with unilateral EACC have been treated by EES. Using a bimanual technique, canaloplasty has been performed using tragal perichondrium, cartilage, or artificial bone. Symptoms, signs, and reconstruction technique have been assessed and the primary endpoint: healing time was compared with benchmark values in the literature. RESULTS During the 26 months study period all of our nine Naim stage III EACCs were successfully treated by EES with median healing time of 23.8 days. EACC limited to the external auditory canal (Naim stage III) represented an ideal target for EES minimizing tissue damage and thus median healing time compared with retroauricular (42-56 d) or endaural (59 d) surgical techniques. DISCUSSION Shorter healing time helped to reduce skepticism toward a surgical treatment of EACC from the patient's perspective. Moreover, EES relied on reduced bulky equipment, dressing time, and complex maintenance compared with microscopic techniques. CONCLUSION Transcanal endoscopic surgery is a valid treatment option for EACC up to Naim stage III. Moreover, the described procedure fosters in our eyes the teaching of our residence to get familiar with the basic steps of EES.
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Yan Y, Dong S, Hao Q, Liu R, Xu G, Zhao H, Yang S. Clinical analysis on surgical management of type III external auditory canal cholesteatoma: a report of 12 cases. Acta Otolaryngol 2016; 136:1006-10. [PMID: 27118359 DOI: 10.3109/00016489.2016.1173227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate surgical management of type III EACC with lesions involving the posterior external auditory canal and mastoid. METHODS This retrospective case review was conducted in 12 patients with type III EACC who underwent intact canal wall mastoidectomy with tympanoplasty and canal wall reconstruction with autologous cortical bone. RESULTS During the follow-up, all patients obtained successful results on external auditory canal structures and hearing improvement, except for one patient who needed a revision operation for the fistula between the reconstructed wall and the mastoid. CONCLUSION Intact canal wall mastoidectomy with tympanoplasty and canal wall reconstruction with autologous cortical bone was proved to be an effective and inexpensive choice for the patients with type III external auditory canal cholesteatoma (EACC) to achieve optimal outcomes.
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Affiliation(s)
- Yan Yan
- Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, PR China
| | - Siqi Dong
- Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, PR China
- Department of Otolaryngology Head and Neck Surgery, The Fourth Hospital, Shenzhen, PR China
| | - Qingqing Hao
- Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, PR China
| | - Riyuan Liu
- Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, PR China
| | - Guangyu Xu
- Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, PR China
| | - Hui Zhao
- Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, PR China
| | - Shiming Yang
- Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, PR China
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Yu SS, Lee KJ, Lin YS. External auditory canal cholesteatoma in patients given radiotherapy for nasopharyngeal carcinoma. Head Neck 2014; 37:1794-8. [PMID: 24989318 DOI: 10.1002/hed.23826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2014] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Patients who undergo radiotherapy (RT) for nasopharyngeal carcinoma (NPC) may develop external auditory canal cholesteatoma (EACC). METHODS The records of patients with newly diagnosed NPC who had received concomitant chemotherapy and RT in a tertiary referral center from 1997 January to 2012 July were retrospectively reviewed. RESULTS RT-related external auditory canal cholesteatoma (RT-related EACC) was identified in 15 of 833 patients given RT for NPC. Three patients had EACC in both ears. The interval from completion of RT to the diagnosis of EACC ranged from 0.5 to 15.4 years (mean, 5.6 years). RT-related EACC commonly (75%) invaded the anterior and inferior parts of the external canal wall. Canaloplasty was used in 12 patients to surgically remove cholesteatoma. There was no recurrence of RT-related EACC during the study period. CONCLUSION Patients with NPC might contract RT-related EACC a few years after RT. We hypothesize that a fraction dose of 200 cGy or more induces RT-related EACC.
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Affiliation(s)
- Shiou-Shyan Yu
- Department of Otolaryngology, Chi Mei Medical Center, Tainan, Taiwan
| | - Kuan-Ji Lee
- Department of Otolaryngology, Chi Mei Medical Center, Tainan, Taiwan
| | - Yung-Song Lin
- Department of Otolaryngology, Chi Mei Medical Center, Tainan, Taiwan.,Center of General Education, Southern Taiwan University of Science and Technology, Taipei, Taiwan
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Kim CW, Baek SH, Lee SH, Kim GW, Cho BK. Clinical characteristics of spontaneous cholesteatoma of the external auditory canal in children comparing with cholesteatoma in adults. Eur Arch Otorhinolaryngol 2013; 271:3179-85. [PMID: 24258852 DOI: 10.1007/s00405-013-2820-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 11/07/2013] [Indexed: 12/16/2022]
Abstract
The purpose of this study was to investigate the characteristics of external auditory canal cholesteatoma (EACC) in children through evaluation of the clinical and radiologic features as well as treatment outcomes. The clinical records were retrospectively reviewed for children under 15 years of age diagnosed with spontaneous EACC between March 2004 and December 2011. The clinical data of adults diagnosed with spontaneous EACC during the same period were evaluated to compare with EACC in children. Eight patients (3 males and 5 females) with pediatric EACC and 18 patients (7 males and 11 females, 20 ears) with adult EACC were included within the boundary of the study. The mean ages were 12.4 years (age range 9-15) for pediatric EACC and 49.8 years (age range 29-79) for adult EACC patients. Follow-up periods ranged from 8 to 86 months (mean 32.5 ± 8.62) in pediatric EACC and from 6 to 72 months (mean 22.2 ± 5.36) in adult EACC. Pediatric EACC, showed involvement most commonly in the posterior wall, while the inferior wall was most commonly involved in adult EACC. Pediatric EACC tended to show a more focal involvement and was not as extensive as adult EACC. Extension into the adjacent structures was similar in both groups, but bony destruction was more common in the adult group. Two children and eight adult patients were treated with surgery, but four adult cases needed more extensive surgical treatment because their disease was widely spread to included areas such as the mastoid segment of facial nerve and the temporomandibular joint. Six pediatric cases treated with conservative management showed no progression of disease on physical examination at the last visit, but two cases of adults progressed and required canaloplasty. Pediatric EACC shows less aggressive behavior compared to adult EACC. Adequate management may work better in pediatric than in adult EACC, even though the treatment modality is conservative management.
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Affiliation(s)
- Chang Woo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hallym University, 445 Gil-Dong, Gangdong-gu, Seoul, 134-701, Korea,
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Dubach P, Mantokoudis G, Caversaccio M. Ear canal cholesteatoma: meta-analysis of clinical characteristics with update on classification, staging and treatment. Curr Opin Otolaryngol Head Neck Surg 2010; 18:369-76. [DOI: 10.1097/moo.0b013e32833da84e] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Current Opinion in Otolaryngology & Head and Neck Surgery. Current world literature. Curr Opin Otolaryngol Head Neck Surg 2010; 18:466-74. [PMID: 20827086 DOI: 10.1097/moo.0b013e32833f3865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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