How do we know it is really congenital cholesteatoma?

Combined Surgical Approach to Giant Cholesteatoma

Objectives:

Cholesteatomas can grow to a remarkable size before clinically making their presence felt. Managing giant cholesteatomas and their complications can become a challenge for the otological surgeon.

Methods:

We describe a case of a giant congenital cholesteatoma of the mastoid in an adult. The lesion extended to the sigmoid sinus, jugular bulb, carotid canal, occipital condyle, and the lateral portion of the first cervical vertebra. Surgical excision was performed using a combined microscopic and endoscopic surgical approach.

Results:

Our combined surgical technique enabled a more accurate removal of the cholesteatoma than a microscopic approach alone, with no surgical complications or damage to the structures affected by the disease.

Conclusions:

Using endoscopic instruments to manage giant cholesteatomas can help to avoid complications and improve surgical radicality.

Clinical features, presenting symptoms, and surgical results of congenital cholesteatoma based on Potsic's staging system

CONCLUSIONS

Potsic's staging system is a clinically useful procedure for evaluating the extent of congenital cholesteatoma (CC).

OBJECTIVES

We investigated the clinical features, presenting symptoms, and surgical results of CC according to Potsic's staging system.

METHODS

A total of 71 patients who had undergone surgery at our hospital were retrospectively analyzed for presenting symptoms, the location of cholesteatoma, and surgical results according to Potsic's staging system.

RESULTS

Of the 71 patients, 21 were classified as Potsic stage I, 9 as stage II, 31 as stage III, and 10 as stage IV. More than half of the patients with early-stage CC (stages I and II) were diagnosed asymptomatically by a chance visit to a clinic or on ear screening. Others were diagnosed following a complaint of hearing loss, acute otitis media, or otitis media with effusion. The location of CC varied somewhat by stage. In stage I CC, the most frequent location was behind the anterior-superior quadrant of the tympanic membrane; however, in stage III CC, it was behind the posterior-superior quadrant. All patients were treated surgically. Recurrence was detected in 2 of the 71 patients (2.8%); both had stage II CC. Recurrent lesions were removed during revision surgery.