[Is routine histopathologic examination of middle ear cholesteatoma necessary?]

BACKGROUND

In the course of restoration of the middle ear, routine histological examinations are initiated in many cases, although a middle ear cholesteatoma can be clinically diagnosed in a normal case.

AIM OF THE STUDY

To determine the correlation between the surgeons' diagnosis and that of the pathologist and comparison with literature data. To check the rate of unexpected diagnoses. Analysis of the costs and survey of German ENT clinics with regard to handling of the histological examination in suspected cholesteatoma.

MATERIALS AND METHODS

Retrospective evaluation of cholesteatoma cases of the ENT Department of the University Medical Center of Mainz from 2010-2015. Germany-wide postal survey of ENT clinics.

RESULTS

In all, 449 operations for the rehabilitation of a middle ear cholesteatoma, of which there were 312 (69.5%) first diagnoses and 137 (30.5%) recurrences. A histological examination was conducted in 78.6%. For first diagnoses, the sensitivity of the clinical assessment was 97.9%, specificity 10%, positive predictive value 96.3%, and negative predictive value 16.7%. Recurrences showed values of 100%, 40%, 97.1% and 100%. Unexpected malignant findings did not occur. This routine histological examination was performed by 58.6% of German ENT hospitals. A total of 80% of those questioned this to be useful. A histological examination cost an average of 14.06 €.

CONCLUSION

Intraoperatively, there is a high degree of accuracy in diagnosing cholesteatoma. The cost factor of the histological examination is low and should not be the basis for the decision. The ear microscopy and the experience of the ear surgeon should be decisive for the decision for histological examination.

[Health-related quality of life as an outcome criterion in traumatology]

Health-related quality of life is a multidimensional concept which describes relevant aspects of physical, emotional and social well-being as reported by patients. Numerous generic and disease-specific instruments for measuring health-related quality of life have been developed and in addition preference-based instruments are available for use in health economic evaluation. The SF-36 and EQ-5D questionnaires belong to the most frequently used generic measures of quality of life. The Trauma Outcome Profile (TOP) and the Quality of Life after Brain Injury (QOLIBRI) questionnaires are disease-specific measures designed to assess health-related quality of life after trauma. In the context of a brief description of these questionnaires several examples of their use in studies of patients after trauma are given. These examples show that successful conceptual and methodological developments in quality of life research provide a sound basis for patient-oriented outcome assessment after trauma.