The current standard treatment of chronic otitic media with cholecteatoma

Abstract

BACKGROUND: Currently there are two main techniques for cholesteatoma surgery: the closed technique (wall up) and the open technique (wall down). The canal wall down mastoidectomy in cholesteatoma can secure a good operation field and easy removal of the lesion. However, there are some problems: the lifelong care of the cavity, dizziness due to the exposed semicircular canal, difficulty with the fitting of a hearing aid as well as poor cosmetics. The canal wall up technique has a better hygienic status and better functional outcome. This technique is associated with a higher rate of residual disease and a higher rate of recurrent disease. To prevent both residual and recurrent cholesteatoma, we performed canal wall down technique with the obliteration of paratympanic spaces for patients with acquired cholesteatoma. MATERIAL AND METHODS: This paper studies the long-term outcomes of surgical treatment of chronic suppurative otitis media with cholesteatoma to prevent residual disease and its relapses. The results of the postoperative observation of 189 patients during the period from 2009 till 2014 are presented. All patients underwent sanation surgery with the obliteration of paratympanic spaces followed by the restoration of the posterior wall of the external auditory meatus and simultaneous tympanoplasty (closed-type surgery). The patients were examined one year after the treatment with the use of the MRI technology using the non-EPI DWI regime to monitor the residual and recurrence cholesteatoma. RESULTS: We analyzed the postoperative results from 189 patients. The follow-up observation revealed 11cases of residual cholesteatoma. Recurrent cholesteatoma was not observed during the follow-up periods. CONCLUSION: Long-term follow up indicated that the canal wall down technique with bony obliteration is a safe method with which to treat primary cases and to reconstruct unstable cavities. The MRI technology in the non-EPI DWI regime was successful in differentiating soft tissues and enabling the detection of residual or recurrent cholesteatoma after a canal wall down bony obliteration technique procedure.