Preservation of labyrinth and facial function in extensive cholesteatoma

Abstract

Surgery for cholesteatoma is a challenge, especially in extensive cholesteatomas with invasion around the facial nerve and the labyrinth. Presence of facial weakness, vertigo and deafness together with chronic discharge from the ear usually indicates a more advanced disease. One hundred and twenty ears with cholesteatoma were reevaluated; in seventy-two patients an open technique was used and in forty-eight a closed technique. In two patients there was a preoperative facial paresis and one suffered from facial tics preoperatively. The facial function was more frequently deranged in patients with labyrinth erosion than in patients without. In the group of patients where the labyrinth was involved the bone conduction remained unchanged postoperatively, except for a few patients where a slight improvement was noted at frequencies of 500 and 2000 Hz. The improvement of bone conduction in some of the patients is probably dependent on recovery of the inner ear mechanism. A rather high proportion of fistulae patients had an exposed facial nerve and or a preoperative facial dysfunction, which, however, returned to normal postoperatively. As a conclusion, ears with cholesteatoma combined with labyrinthine symptoms are more frequently associated with a dehiscent facial nerve than other ears and disturbed facial function is then more common. During surgery it is important to be aware of the risk of an uncovered facial nerve.