Cases Of Cholesteatoma Research Articles

Surgical treatment of adult cholesteatoma: long-term follow-up using total reconstruction procedure without staging

Conclusions: A total of 330 cases of adult cholesteatoma were operated with canal-wall down (CWD) and total reconstruction procedure (TRP) without staging. Independent of preoperative middle ear conditions, cholesteatoma extent and localization, long-term improvement of hearing with a low incidence of residual and recurrent disease were achieved. Objectives: To evaluate long-term surgical and hearing results using a well-defined surgical technique without staging in adult cholesteatoma. Methods: The same CWD surgical technique, including obliteration of the mastoid cavity, reconstruction of the canal wall, and ossiculoplasty with autologous bone, was used by three senior surgeons (1982–2004). Preoperative and postoperative pure tone average (PTA) for air conduction (AC), bone conduction (BC), and air–bone gap (ABG) were assessed and compared 1, 3, and 6 years after surgery. Various prognostic factors with potential influence on long-term hearing outcome were evaluated. Results: Recurrence of AC occurred in 10%, residual disease in 3%. Six years after surgery all patients except one had a dry ear and over 92% of all cases were water resistant. Three patients developed complete deafness. Long-lasting improvement and/or preservation of hearing, with maintenance of PTA-ABG closure in 68% of all cases within 20 dB, were obtained. Sixty-four (19%) ossicular revisions were performed.

Two Cases of Multiple Cholesteatomas Combined with Attic Cholesteatoma

We report herein on 2 of multiple cholesteatomas combined with attic cholesteatoma. Microscopic examination of the tympanic membrane and CT scan of the temporal bone indicated attic cholesteatoma in each case. Surgical exploration demonstrated the presence of another cholesteatoma and there was no epithelial continuity between the lesion and the attic cholesteatoma. In both cases, it is probable that the cholesteatoma of the mastoid antrum and attic cholesteatoma were unrelated. In case 1, chronic inflammation may have obstructed the tympanic isthmus and the pars flaccida was retracted secondarily. In case 2, both lesions may have been congenital and one of them perforated the tympanic membrane and appeared to be acquired cholesteatoma.

Posttraumatic Cholesteatoma Complicated by a Facial Paralysis: A Case Report

The posttraumatic cholesteatoma is a rare complication of different types of the temporal bone damage. Its diagnosis is often done after several years of evolution, sometimes even at the stage of complications. A case of posttraumatic cholesteatoma is presented that was revealed by a facial nerve paralysis 23 years after a crash of the external auditory canal underlining the importance of the otoscopic and radiological regular monitoring of the patients with a traumatism of the temporal bone.

A Case of External Auditory Canal Cholesteatoma Caused by Osteoradionecrosis of the Temporal Bone after Irradiation Therapy for a Brain Tumor

A Case of External Auditory Canal Cholesteatoma Caused by Osteoradionecrosis of the Temporal Bone after Irradiation Therapy for a Brain Tumor

Regeneration of Mastoid Air Cells <i>in Vivo</i> Using Autologous Cortical Bone

Purpose: This was a preliminary study to assess surgical construction and regeneration of mastoid air cells in the treatment of cholesteatoma. Methods: Two-stage tympanoplasty with mastoidectomy was performed in four cases of unilateral cholesteatoma with sclerotic mastoid. During the first-stage operation, small fragments of autologous cortical bone were inserted into the cavity after mastoidectomy to form a honeycomb-like structure. Reconstruction of the lateral wall of the mastoid cavity was performed using the mastoid cortical bony plate. Pre- and postoperative mastoid volume was evaluated by three-dimensional reconstruction based on high-resolution computed tomography (HR-CT) images. Results: HR-CT images after the first-stage operation showed that mastoid volume had increased in all subjects. Macroscopic inspection during the second-stage operation revealed that the honeycomb-like structure made of bony fragments and covered by thin mucosa in the mastoid cavity was stable, with no evidence of effusion or granulation tissue. No retraction of the eardrum, middle ear effusion or recurrence of cholesteatoma was observed, and the hearing level on a pure-tone audiogram was improved in any subject 60 - 94 months after the second-stage operation. Conclusion: Surgical construction and regeneration of mastoid air cells using autologous cortical bone can be useful in treatment of cholesteatoma with arrested mastoid pneumatization.

External ear canal cholesteatoma after ventilation tube insertion and mastoidectomy

Etiopathogenetically, there are two types of chollesteatomas: congenital, and acquired. Numerous theories in the literature try to explain the nature of the disease, however, the question about cholesteatomas remain still unanswered. The aim of the study was to present a case of external ear canal cholesteatoma (EEC) developed following microsurgery (ventilation tube insertion and mastoidectomy), as well as to point ant possible mechanisms if its development. A 16-year-old boy presented a 4-month sense of fullness in the ear and otalgia on the left side. A year before, mastoidectomy and posterior atticotomy were performed with ventilation tube placement due to acute purulent mastoiditis. Diagnosis was based on otoscopy examination, audiology and computed tomography (CT) findings. CT showed an obliterative soft-tissue mass completely filled the external ear canal with associated erosion of subjacent the bone. There were squamous epithelial links between the canal cholesteatoma and lateral tympanic membrane surface. They originated from the margins of tympanic membrane incision made for a ventilation tube (VT) insertion. The position of VT was good as well as the aeration of the middle ear cavity. The tympanic membrane was intact and of normal appearance without middle ear extension or mastoid involvement of cholesteatoma. Cholesteatoma and ventilation tube were both removed. The patient recovered without complications and shortly audiology revealed hearing improving. Follow-up 2 years later, however, showed no signs of the disease. There could be more than one potential delicate mechanism of developing EEC in the ear with VT insertion and mastoidectomy. It is necessary to perform routine otologic surveillance in all patients with tubes. Affected ear CT scan is very helpful in showing the extent of cholesteatoma and bony defects, which could not be assessed by otoscopic examination alone.

Congenital aural stenosis with first branchial cleft fistula, presenting with recurrent facial nerve palsy, in an elderly patient

Both duplication anomalies and external auditory canal stenosis can result in cholesteatoma due to retained epithelium. Despite their common origins, the coexistence of these anatomical abnormalities is quite unusual. This cholesteatoma may go unnoticed till adulthood and present with complications. Moreover, first branchial cleft malformations are often unrecognized or misdiagnosed for other inflammatory lesions in the periauricular region. We report a case of middle-ear cholesteatoma in a 68 year old male patient with grade II microtia with canal stenosis and first branchial cleft fistula in supra-auricular region presenting with recurrent infranuclear facial nerve palsy. The patient was managed surgically by excision of fistulous tract, canalplasty, auricular reconstruction and middle ear and mastoid exploration for cholesteatoma. This may probably be the oldest person to be managed surgically for cholesteatoma due to congenital ear anomalies and first such reported case.

Mastoid Cholesteatoma: A Result of Metaplasia

Presence of cholesteatoma in the middle ear of the patients with chronic mucosal otitis media has been reported in the literature. But presence of cholesteatoma only in the mastoid, in the absence of cholesteatoma in the middle ear of a patient with chronic mucosal otitis media, is not reported in the literature. In this article three cases of mastoid cholesteatoma, in patients with a clinical picture of chronic mucosal otitis media is reported along with the literature review.

Congenital Mastoid Cholesteatoma: Case Series, Definition, Surgical Key Points, and Literature Review

We evaluate 3 new cases of congenital cholesteatoma confined to the mastoid process, and compare them with cases presented in the literature in order to better define this rare lesion. We performed a retrospective chart analysis of all congenital cholesteatomas treated surgically in a tertiary referral and skull base center. We performed a complete analysis (history, radiologic, and surgical) of all patients with congenital cholesteatoma confined to the mastoid process; we then performed a literature review and compared our findings with the presented cases. The results of preoperative imaging were in line with the surgical findings. The most important surgical issue in this type of lesion was the management of the sigmoid sinus and the jugular bulb. Half of the cases previously reported in the literature appeared not to fulfill the definition criteria of a congenital cholesteatoma of the mastoid process. Congenital cholesteatoma confined to the mastoid process is a rare lesion, and is even more exceptional upon critical review of the literature. Symptoms are often lacking or nonspecific, and although cases have a congenital origin, the diagnosis often is not made until adulthood. A combined congenital cholesteatoma group with middle ear and mastoid features seems to fill in the gap in the definition. Management of the sigmoid sinus and the jugular bulb is the most demanding surgical key point.

선천성진주종의 임상적 분석

Backgrounds and Objectives: Recently congenital cholesteatoma of middle ear has been diagnosed in earlier stage and its clinical manifestation has showed changed clinical manifestation, comparing that of reported literature. Aim of this study were to elucidate of clinical finding, extent of the cholesteatoma, staging, operative procedure and rate of postoperative recurrence in congenital middle ear cholesteatoma. Materials and Methods: 47 cases of congenital cholesteatoma had been treated in Department of Otorhinolaryngolgy of Pusan National University Hospital from 1997 to October of 2010 and were reviewd retrospectively. Results : Congenital cholesteatoma showed male preponderance, and had diagnosed incidentaly (46.8%) and most common symptom was hearing loss. Most were found in tympanum only (70.2%) and more found in posterior portion than in anterior portion. Rate of each stage is similar distribution in stage I, II, III, IV. Recurrence rate showed 14.9%. Conclusions :Early diagnosis and early intervention is important to avoid recurrence and morbidity. (J Clinical Otolaryngol 2011;22:196–200)

Cholestéatome congéntial

To report on two cases of congenital cholesteatoma in patients aged 1 month. To review the clinical and radiological features of congenital cholesteatoma and to clarify the contribution of the CT scan in the diagnosis and the preoperative workup. The authors report two observations of congenital cholesteatoma. These children were investigated using high-resolution CT. The treatment was surgical in both cases. The children were 1 month old, presenting with facial paralysis. In the otoscopic exam, the tympanic membrane was normal in both cases, with a whitish retrotympanic soft mass. The diagnosis of congenital cholesteatoma was made based on the CT data. Congenital cholesteatoma is rare. Otoscopic examination must be undertaken during the physical exam of a child at a young age to establish an early diagnosis. CT scan allows positive diagnosis and a precise preoperative workup.

TNF‐Alpha Expression on Acquired Cholesteatoma Behavior

Objective: This article aims to show the qualitative TNF-alpha expression on acquired cholesteatoma behavior and the recurrence prognostic factor. Method: We retrospectively selected 2 groups of patients with acquired cholesteatoma who underwent open tympanomastoidectomy to remove the disease: the first group had recurrence after at least 2 years, and the second group had the disease under control over 4 years. Results: Immunohistochemistry was done using a TNF-alpha receptor marker in both groups and was evaluated by 3 observers who followed the patterns according to the relationship between the reagent expression and the epithelium. The 0 level means no reagent expression, the + level means that a third were dyed, the ++ level means more than two thirds were dyed, and the +++ level means the fullest extent of the epithelium was dyed. The mean expression of TNF-alpha was slightly higher in the group with recurrence than in the control group, respectively 1.7 + 1.4 +, but there was not detected a statistically significant difference between the groups ( P = .456). Conclusion: Although several articles show TNF-alpha action bone destruction in cholesteatoma cases in vitro, the qualitative expression of TNF-alpha was not a good predictor in cholesteatoma recurrence.

Acquired Cholesteatoma

Reclassification of acquired cholesteatoma into the commonly observed presentations of this condition to provide a simple and clear grouping that indicates the pathology, management, and outcomes of the group cases. Virgin acquired cholesteatoma cases from a single center managed from 1986 to 2008 (515 cases). Cases were managed by transcanal (20%) or intact canal wall techniques. Wall repairs successively used autograft cartilage (transcanal and early intact canal wall mastoidectomy cases), hydroxylapatite plates (1989-2007), or titanium sheeting (2007). Drum repairs used cartilage-perichondrial composite grafts. Assembly techniques were the preferred ossiculoplasty method. Distribution: attic, 41%; pars tensa, 45%; and combined attic-pars tensa, 14%. Unclassifiable cases (n = 14) were excluded. Contralateral disease was present in 15% and effusions in 34% during or after surgery. Cell formation was most extensive in attic disease, least in combined patterns. Ossicular pathology was worse in the collapsed drum cases. Attic cases had the best hearing outcomes but risked recurrent disease, which required precise countermeasures. Overall, the combined pattern group carried the worst prognosis. Compared with previous methods, the clinical classification proved simple, descriptive, and comprehensive. It provides a readily discerned practical basis for clinical management and research purposes.

Surgical management options and postoperative functional outcomes of petrous apex cholesteatoma

Conclusion: In cases of petrous apex (PA) cholesteatoma, radical removal should be prioritized over an unreasonable sparing of hearing or facial symmetry. Nevertheless, for patients with serviceable hearing and spared inner ear structures, conservative approaches may be applicable. Restoration of facial nerve (FN) function is achievable by reanimation procedures. Objectives: To analyze clinical manifestations, surgical techniques, and postoperative functional results of PA cholesteatoma. Methods: From 1987 to 2010, 13 cases of PA cholesteatoma underwent operations. Clinical, audiological, and radiological findings, surgical approach, and postoperative functional outcomes were analyzed retrospectively. Results: The most common symptoms were hearing loss and FN paralysis. All PA cholesteatomas extended to the middle ear; 10 (76.9%) through the anterior-superior route, whereas the other 3 (23.1%) were through the posterior-superior route. In 10 patients, labyrinthectomy was inevitable because of inner ear invasion. However, three limited cholesteatomas were removable via the middle cranial fossa or transmastoid approach without changing the bone-conduction threshold. Among six cases with FN paralysis, one underwent interposition graft, two FN decompression, and the others hypoglossal-FN anastomosis. One FN decompression case recovered to House-Brackmann grade I, and all other reanimation cases finally presented with grade IV. There were no major complications or recurrences during the follow-up period.

Unilateral cholesteatoma and habitual sniffing

Objectie: To examine the clinical findings of acquired bilateral cholesteatoma with special reference to incidence of habitual sniffing and sniff-related negative middle ear pressure. Methods: Eighty-eight fresh cases of unilateral cholesteatoma and 33 fresh cases of bilateral cholesteatoma, which were operated on at Department of Otolaryngology, Hyogo College of Medicine, were examined in this study. Responses to a detailed questionnaire were obtained from the patients concerning about the habit of habitual sniffing to relieve aural symptoms such as auralfullness, autophonia or hyperacusis. The same questionnaire was obtained from unilateral cholesteatoma patients to compare the incidence of habitual sniffing with that of patients with bilateral cholesteatoma. We measured the negative middle ear pressure at the time of sniffing by using TTAG (tubo-tympano aerodynamic graphy, Nagashima Co. Ltd, Tokyo). We also compared the positive percentage of the sniff test in bilateral cholesteatoma with in unilateral cholesteatoma and normal controls. Sniff test was performed in 30 patients with bilateral cholesteatoma, 20 patients with unilateral cholesteatoma and 20 normal controls. Results: In 33 patients with bilateral cholesteatoma (66 ears), 57 ears had the pars flaccida type (86.4%) and 9 ears had the pars tensa type (13.6%). Cholesteatoma of pars flaccida type were predominant in bilateral cholesteatoma. The rate of habitual sniffing of bilateral cholesteatoma (23/33, 69.7%) was significantly higher than that of unilateral cholesteatoma (21/88, 23.9%). The incidence of positive sniff test in bilateral cholesteatoma (19/30, 63.3%) was significantly higher than in unilateral one (6/20, 30%) and normal control (3/20, 15%). Conclusions: Habitual sniffing was closely related to the pathogenesis of bilateral cholesteatoma, especially in cases with bilateral pars flaccida type. © 2002 Elsevier Science Ireland Ltd. All rights reserved.

Three cases of congenital cholesteatoma associated with cholesterol granuloma

Three cases of congenital cholesteatoma associated with cholesterol granuloma

A study on 13 cases of congenital open-type cholesteatoma

A study on 13 cases of congenital open-type cholesteatoma

An attic cholesteatoma case with multiple epithelial pearls in the mastoid antrum

An attic cholesteatoma case with multiple epithelial pearls in the mastoid antrum

B120 Aberrant carotid artery: implications on the surgery of the cochlear implant

The combined approach technique (CAT) is a variation of the classical the mastoidectomy-posterior tympanotomy technique (MPTA) that combines a transcanal approach to cochleostomy with a reduced posterior tympanotomy for insertion of electrodes.To compare and evaluate long-term safety and effectiveness outcomes obtained with the CAT and with MPTA approach in patients submitted to cochlear implant (CI) surgery. Design: series study.Patients who underwent CI using CAT or MPTA at a Brazilian center were followed in a cohort study. Main outcomes were complications, audiometric performance and radiological evaluation of electrode position.Fourty-four patients were implanted using CAT and 31 MPTA. There were no cases of facial nerve paralysis, mastoiditis, cholesteatoma or cerebrospinal fluid leaks after 3.4±1.0 years. Radiological evaluation of electrode position revealed that the median number of electrodes outside the cochlea was 0 in CAT and 3 in MPTA groups (p < 0.001). There were no differences between both surgical approaches in terms of mean pure-tone thresholds with CI at all frequencies.Long-term follow-up data showed that the transcanal route to cochleostomy, combined with a reduced posterior tympanotomy, is a safe alternative approach in cochlear implant surgery, with no related major complications and fewer cases of electrode migration when compared with the MPTA. These findings encourage the use of the transcanal route to cochleostomy as an alternative approach option.

Two Cases of Congenital Cholesteatoma of the Tympanic Membrane

Congenital cholesteatoma of the tympanic membrane is rare, and lesions without a history of otitis media or any other adverse events involving the tympanic membrane are extremely rare. We report two cases of this lesion; one was a 3-year-old girl who underwent removal of a cholesteatoma using retroauricular approach and a partial myringoplasty with an underlay technique, and the other was a 2-year-old girl in whom a cholesteatoma was enucleated without grafting. This disease is thought to be of embryonic origin.