Recurrent and residual cholesteatoma rates after different types of sanitation surgery on middle ear

Abstract

Aim. To compare the recurrent and residual cholesteatoma rates after four variants of sanitation operations on the middle ear (open and closed techniques, mastoidal cavity obliteration and posterior wall reconstruction using the allogeneic cartilage).Methods. The study involved 231 patients: 123 men and 108 women aged 15 to 64 years. Patients were divided into four groups depending on the type of surgery. Patients of all groups were examined in the distant period - a minimum within 1 year (range 1-15 years). The surgery results were evaluated using otomicroscopy (OPMI Sensera microscope) by two parameters. The first parameter - the presence or absence of recurrent and residual cholesteatoma in postoperative period. The second parameter - «bad», adverse retraction pockets occurrence in postoperative period. We referred to them cases when the pocket was in medial section of the external auditory canal (i.e. closer to neotympanic membrane or tympanic membrane remnants), had a narrow or convoluted entrance (i.e. epidermal masses evacuation from pocket was difficult) and was filled with epidermal, sulfur or fungal masses.Results. Open type of sanitation operation showed the lowest likelihood of cholesteatoma recurrence - 1.27%. Trepanation cavity obliteration method using fascial-muscle flap on the lower pedicle showed the highest rate of cholesteatoma recurrence - 33.33%.Conclusion. The minimum probability of recurrent and residual cholesteatoma occurrence is characteristic for open type of sanitation operation; method of trepanation cavity obliteration using fascial-muscle flap is not recommended for use because of the high rate of adverse outcomes.