Cholesteatoma: Influence of surgical technique and EAONO/JOS stage on audiological results

INTRODUCTION AND OBJECTIVE

The treatment of cholesteatoma is surgical in most cases. When it is indicated, it is preferable to choose a reconstructive surgical technique with the dual purpose of eradicating the disease and preserving or improving the patient's hearing. In 2017, the European Academy of Otology and Neuro-Otology/Japanese Otological Society (EAONO/JOS) published a new cholesteatoma classification. The aims of this study are to determine the influence of the surgical technique use and this classification on patient's hearing outcomes.

METHODS

A retrospective study that include patients who underwent reconstructive surgery of cholesteatoma between 2012 and 2017 is carried out. Based on pre-surgical computed tomography (CT) images, disease is staged according to the EAONO/JOS classification. Hearing outcomes obtained by pre and postoperative pure tone audiometry are analysed according to the surgical technique used and according to the stage of the disease.

RESULTS

143 patients with no statistically significant differences in hearing thresholds before surgery are included. One year after surgery, all the patients' airbone pure tone average (PTA) and mean differential auditory threshold have improved significantly (P = .01 and P = .001). Those patients who undergo tympanoplasty with two-stage canal wall up mastoidectomy presente better postsurgical air PTA and postsurgical mean differential auditory threshold outcomes (P=.007 and P=.014) than those patients who underwent tympanoplasty with canal wall down mastoidectomy. Moreover, the patients who underwent tympanoplasty with two-stage canal wall up mastoidectomy had improved airbone PTA and mean differential auditory threshold one year after the surgery with statistical significance (P=.001 and P=.013). The mean differential auditory threshold is also better (P=.008) in the patients who undergo tympanoplasty with canal wall down mastoidectomy one year after the procedure.

CONCLUSIONS

Reconstructive surgical techniques improve hearing one year after surgery. In our study, this improvement is significantly greater with tympanoplasty with two-stage canal wall up mastoidectomy.

Multidimensional staging system for pediatric acquired cholesteatoma: A 30-year verification data

OBJECTIVE

This article presents a points-based prognostic prediction model for pediatric acquired cholesteatoma, incorporating the multidimensional factors that contribute to surgical failure.

METHODS

This study included 132 ears with acquired cholesteatoma from 128 children (≤18 years) identified between 1982 and 2012. Each case was scored for the extent of the cholesteatoma, history of grommet insertion, age of the patient, ossicular destruction, and otorrhea. The patients were classified as stage I, II, or III. We compared differences between stages regarding the cumulative rates of recidivism and linear trends in these rates.

RESULTS

Among stage I cases, the rate of cumulative recidivism was 0%; however, among stage 2 cases, this increased with time, eventually leveling off at 15.7% after 18 years of follow-up. The same was observed among stage III cases, which leveled off at 34.1% after 17 years of follow-up. In the second half of the cohort and the entire cohort, differences in the cumulative recidivism curves reached statistical significance, as did the linear trends (all p<0.05).

CONCLUSIONS

Our findings demonstrate the efficacy of the proposed multidimensional staging system in linking the severity of cholesteatoma to outcomes, thereby enabling the stratification of patients according to prognosis in order to identify children at risk of recidivism.

Updates and knowledge gaps in cholesteatoma research

The existence of acquired cholesteatoma has been recognized for more than three centuries; however, the nature of the disorder has yet to be determined. Without timely detection and intervention, cholesteatomas can become dangerously large and invade intratemporal structures, resulting in numerous intra- and extracranial complications. Due to its aggressive growth, invasive nature, and the potentially fatal consequences of intracranial complications, acquired cholesteatoma remains a cause of morbidity and death for those who lack access to advanced medical care. Currently, no viable nonsurgical therapies are available. Developing an effective management strategy for this disorder will require a comprehensive understanding of past progress and recent advances. This paper presents a brief review of background issues related to acquired middle ear cholesteatoma and deals with practical considerations regarding the history and etymology of the disorder. We also consider issues related to the classification, epidemiology, histopathology, clinical presentation, and complications of acquired cholesteatoma and examine current diagnosis and management strategies in detail.