Abstract
IntroductionAcquired middle ear cholesteatoma can be classified as primary or secondary. Although both can result in hearing loss, it is still controversial whether there is an association between the type of cholesteatoma and the degree of hearing loss. ObjectiveTo analyze the association between hearing loss and the type of acquired cholesteatoma, and the status of the ossicular chain. MethodsThis was a cross-sectional historical cohort study involving patients diagnosed with acquired cholesteatoma who were surgically treated. Air and bone conduction thresholds, air–bone gaps and the status of the ossicular chain were analyzed for both types of cholesteatoma. ResultsEighty patients aged 5–57 were included in the study. Fifty-one patients had primary cholesteatoma and 29 had secondary cholesteatoma. Both types of cholesteatoma determined greater air–bone gaps at 0.5kHz. Secondary cholesteatoma determined greater hearing loss in all analyzed frequencies and higher air conduction and air–bone gap means. ConclusionThere was association between hearing loss and the type of cholesteatoma. Secondary cholesteatoma resulted in greater hearing impairment.
Highlights
Cholesteatoma is defined as the presence of skin in any airfilled area of the temporal bone, and can be congenital or acquired.[1]
As for the hearing impairment at the different frequencies, it was observed that the bone threshold was higher at frequencies 2 and 4 kHz, both in primary and secondary cholesteatoma (Table 2); the air threshold was higher at frequencies 0.5 kHz and 1 kHz in primary cholesteatoma and similar at all frequencies in secondary cholesteatoma (Table 3), whereas the gap was higher at a frequency of 0.5 kHz in both types of cholesteatoma (Table 4)
This assumption was confirmed by this study, in which secondary cholesteatoma was associated with more severe hearing loss
Summary
Cholesteatoma is defined as the presence of skin in any airfilled area of the temporal bone, and can be congenital or acquired.[1]. Cholesteatomas determine mechanical compression of adjacent structures and have cells with hyperproliferative characteristics (cytokeratin 16, KI67, and inflammatory cytokines), which may cause temporal bone and ossicular chain erosion, resulting in hearing loss.[4,11,12] For this reason and due to the presence of fetid otorrhea, they result in psychosocial damage. As they have a major impact on activities of daily living, they can limit future job opportunities and cause social inclusion difficulties.[9]
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