Cholesteatoma Surgery With Three Different Methods: A Clinical Study For Recidivism Research

Abstract

Introduction: The study aimed to determine the rates of recidivistic disease after primary surgery, localization of cholesteatoma, pathologic findings detected during the operation, and the additional surgical procedures performed in patients with chronic otitis media with cholesteatoma. Materials and Methods: Three hundred forty-five patients suspected of chronic otitis media with cholesteatoma searched their files and operation notes in Cukurova University Hospital between January 2010 and January 2020 retrospectively. Three surgical techniques were applied: Canal Wall Down (CWDM), Canal Wall Up (CWUM), and Radical (RM) mastoidectomy. Cholesteatoma localization, ossicular system status, condition of the facial canal, semicircular canal defects, tegmen defect, tympanoplasty, and whether hearing reconstruction is performed were investigated. In follow-up, revision surgeries were performed on 61 patients with suspicions of recidivistic disease. The revision surgery region was where cholesteatoma was detected, and the condition of the ossicles was investigated. Patients' demographic characteristics, follow-up time, the recidivism rate in surgical method, cholesteatoma localization in the first surgery, and cholesteatoma localization in revision surgery were compared. Results: 27.2% of 345 patients were CWUM, 23.5% were CWDM, and 49% were RM. Cholesteatoma localization was 60.9% of them in mastoid cavities, 59,4% of them in the attic and epitympanum, 56,2% of them in the middle ear, and 12,8% of them in only sinus tympani and facial recesses. Patients were followed for a mean of 36 months. In the follow-up period, revision mastoidectomy was performed for ten patients with recidivistic disease. Revision rates after CWUM were 62,3%, revision rates after CWDM were 9,8%, and revision rates after RM was 27,9%. Conclusions. The choice of surgical procedure is an essential parameter in forming a recidivistic disease. Especially in open technical surgeries (CWDM and RM), the risk of recidivistic disease is significantly lower than that of closed technical surgeries (CWUM). Keywords: Cholesteatoma, recidivistic disease, ossicle erosion, radical mastoidectomy