Cholesteatoma Patients Research Articles

Prevalence of Pseudomonas aeruginosa in cholesteatoma patients in tertiary care hospital in North India

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Chronic suppurative otitis media (CSOM) is middle ear infection that lasts for more than three months and is accompanied by a perforation of tympanic membrane. Cholesteatoma is a well know complication of CSOM. Prevalence of CSOM varies between racial and socioeconomic groups. The aim of present study was to determine the principal bacteria in ear discharge in patients with cholesteatoma. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This was a prospective study conducted in department of ENT in tertiary care hospital and medical college in north India from March 2017 to May 2017.Total 80 patients attended ENT OPD with complain of ear discharge and deafness during the study period, but only 47 patients were clinically diagnosed unsafe type of CSOM or cholesteatoma. Ear swabs were collected and send for microbiology laboratory for bacteriological process. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Out of 80 patients, 47(58.75%) were clinically diagnosed cholesteatoma and of 29(61.70%) were male and 18(38.29%) were female. Most commonly affected age group was between 10 to 20 year (40.42%) followed by 21 to 30 (21.27%). More than 60 Year was less affected by cholesteatoma. Most common isolated organism was <em>Pseudomonas aeruginosa</em> (66.66%) followed by <em>Klebsiella pneumonia</em> (19.44%) and we used <em>Piperacillin tazobactum</em> and amikacin, and ciprofloxacin in all cases in perioperative period and noticed good response and modified radical mastoidectomy was done in all patients. </span></p><p class="abstract"><strong>Conclusions:</strong> <em><span lang="EN-IN">P. aeruginosa</span></em><span lang="EN-IN"> was found to be the most common isolate in CSOM with cholesteatoma case and piperacillin-tazobactum, amikacin, and ciprofloxacin was found to be cost effective antibiotics.</span></p>

Morphological Characteristics of Osseous External Auditory Canal and Its Relationship With External Auditory Canal Cholesteatoma in Patients With Congenital Aural Stenosis.

To investigate the characteristics of stenotic external auditory canal (EAC) (e.g., shape, length, orientation, and curvature) and to compare them with those of the cholesteatoma and no cholesteatoma groups, which may help to explain cholesteatoma formation to a certain degree. Computed tomography scans of two groups of patients (with and without EAC cholesteatoma) were analyzed. We determined the degree of microtia, the stenosis of EAC, radius and curvature of osseous EAC bending (abbreviated as OEB-r and OEB-c, respectively), and other anatomic parameters of EAC by using Mimics and Matlab. There was no significant difference in the degree of microtia between the cholesteatoma and no cholesteatoma groups using the Marx grading system. Additionally, no significant difference was found in the stenosis of EAC between the two groups. The OEB-r was smaller in the cholesteatoma group (4.62 ± 0.62 mm) than in the no cholesteatoma group (7.41 ± 0.50 mm), and the OEB-c was found to be larger in the cholesteatoma group (1.55 ± 0.05 × 10 mm) than in the no cholesteatoma group (1.10 ± 0.10 × 10 mm). Moreover, the OEB-c (OR, 8.60; 95% CI, 2.67-27.75) was associated with EAC cholesteatoma formation. The curvature of osseous EAC in the cholesteatoma group was significantly larger than that in the no cholesteatoma group. It is suggested that the curvature of osseous EAC was a risk factor for EAC cholesteatoma formation.

Risk Factors of Recurrence in Pediatric Congenital Cholesteatoma.

To examine the risk factors of recurrence in pediatric congenital cholesteatoma. Retrospective chart review. University hospital. Sixty-seven patients having tympanic type of congenital cholesteatoma under 15-years old at surgery. Canal wall-up tympanomastoidectomy (n = 30) or transcanal atticotomy/tympanoplasty (n = 37) was performed depending on cholesteatoma extension, 16 of which were followed by second-look surgery. Preoperative computed tomography (CT) before second-look surgery or follow-up CT was performed to detect residual recurrence 1 year after the surgery. Cholesteatoma found at the second surgery was also included in the recurrence. All patients had no recurrent cholesteatoma at the last follow-up (median, 61 mo after surgery). Possible predictive factors were compared between the groups. Residual cholesteatoma and retraction cholesteatoma occurred in 21 and 6%, respectively. There was no significant difference in age, sex, and type of cholesteatoma (open or closed) between the groups; however, Potsic stage and status of stapes involvement were more advanced in the residual cholesteatoma group. All residual lesions could be detected by follow-up CT or by second-look surgery. All of four retraction cholesteatoma patients were male, young at the surgery and in stage IV. Recurrence mostly occurred as residual cholesteatoma, suggesting that CT is recommended as a follow-up tool for congenital cholesteatoma. Advanced lesions had the risk of residual cholesteatoma, suggesting that complete removal of epithelium is important. Although rare, young advanced-stage patients had risk of retraction cholesteatoma and therefore normal mucosa should be preserved as much as possible for these patients.

Accuracy of turbo spin-echo diffusion-weighted imaging signal intensity measurements for the diagnosis of cholesteatoma.

We aimed to evaluate the diagnostic accuracy of turbo spin-echo diffusion-weighted imaging (TSE-DWI) at 3 T, for cholesteatoma (CS) diagnosis, using qualitative and quantitative methods with numerical assessment of signal intensity (SI), signal intensity ratios (SIR), and apparent diffusion coefficient (ADC) values. In this retrospective study, two blinded observers independently evaluated the preoperative TSE-DWI images of 57 patients who were imaged with a presumed diagnosis of CS. Qualitative assessment with respect to the SI of the adjacent cortex and quantitative measurements of SI, SIR, and ADC values were performed. Surgery with histopathologic examination revealed 30 CS patients and 27 patients with non-cholesteatoma (NCS) lesions including chronic inflammation and cholesterol granuloma. On TSE-DWI, 96.7% of the CS lesions and none of the NCS lesions appeared hyperintense compared with the cortex. The mean SI and SIR indices of the CS group were significantly higher and the mean ADC values significantly lower compared with those of the NCS group (P < 0.001). Using specific cutoff values for SI (92.5) and SIR (0.9), CS could be diagnosed with 100% sensitivity and specificity. The use of quantitative imaging further increased the sensitivity of the TSE-DWI technique. The quantitative indices of SI, SIR, and ADC of TSE-DWI appear to be highly accurate parameters that can be used to confirm the diagnosis of CS.

Endoscopy-Assisted Ear Surgery for Treatment of Chronic Otitis Media With Cholesteatoma, Adhesion, or Retraction Pockets.

The objective of this study was to analyze the results of endoscopy-assisted ear surgery for the treatment of chronic otitis media with cholesteatoma, adhesion, or retraction pockets.Fifty-one patients who underwent oto-endoscopy-assisted canal wall up tympanomastoid surgery and/or limited anterior atticotomy with tympanoplasty for chronic otitis media with cholesteatoma, adhesion, or retraction pocket from 2006 to 2013 have been included in this study. Eradication of the disease from the middle ear and mastoid air cells was achieved by combination of the oto-microscobic and oto-endoscopic approaches. Second look surgery was performed 18 months later from the initial surgery in selected patients. Age, gender, pre-/postoperative otoscopy findings/audiograms, type of the used prostheses, and follow-up time were obtained from the patient's file. Anatomic integrity rates of the tympanic membrane, the mean gains of air bone gap, on pure-tone audiogram at 4 frequencies and existence of the residual disease were reviewed parameters. Functional evaluation was made in patients with intact tympanic membrane.Of the 51 patients, the ratios of the chronic otitis media with cholesteatoma and isolated adhesive otitis or retraction pocket cases were 74.5% (38/51) and 25.5% (13/51), respectively. Ossicular chain reconstruction was made with PORP in 27 patients and TORP in 20 patients, whereas the ossicular chain was intact in 4 patients. Anatomic integrity rates of the tympanic membrane were 90.2% (46/51). The overall (n = 46) pre-/postoperative mean ABG obtained at 4 frequencies were 28.3 ± 12.26 and 9.18 ± 5.68 dB (P < 0.0001) respectively. Residual cholesteatoma rate was 10.5% (34/38) for chronic otitis media with cholesteatoma patients. However, there was no recurrence or new cholesteatoma formation in isolated retraction pockets or adhesive otitis patients.Oto-endoscopic eradication of the cholesteatoma or epithelial tissue from hidden area after the all visible cholesteatoma removal by oto-microscope improves the quality of surgery, significantly decreases the frequency of the canal wall-down procedure and posterior tympanotomy requirements with acceptable residual cholesteatoma rates.

Association Between Middle Ear Cholesteatoma and Chronic Rhinosinusitis

Chronic rhinosinusitis (CRS) can cause an obstruction of the tubal orifice and thereby compromise ventilation of the middle ear. The resulting negative pressure in the middle ear may, in turn, lead to the formation of an eardrum retraction pocket and subsequent acquired cholesteatoma. This study hypothesizes that CRS may increase the risk of cholesteatoma. To evaluate the risk of cholesteatoma in patients with CRS. This study used a nationwide, population-based claims database to test the hypothesis that CRS may increase the risk of cholesteatoma. The Longitudinal Health Insurance Database of Taiwan was used to compile data from (1) 12 670 patients with newly diagnosed CRS between January 1, 1997, and December 31, 2002, and (2) a comparison cohort of 63 350 matched individuals without CRS, resulting in a CRS vs control ratio of 1:5. Data analysis was performed from June 1 to October 27, 2015. Each patient was followed up for 8 years to identify those in whom cholesteatoma subsequently developed. The Kaplan-Meier method was used to determine the cholesteatoma-free survival rate, and the log-rank test was used to compare survival curves. Cox proportional hazards regression models were used to compute the 8-year hazard ratios (HRs). Diagnosis of cholesteatoma. Among the 76 020 patients enrolled in this study, 35 220 (46.3%) were female; mean (SD) age was 27.57 (22.03) years. A total of 209 patients developed cholesteatoma, 66 (101 084 person-years) individuals from the CRS cohort and 143 (506 540 person-years) from the comparison cohort were diagnosed with cholesteatoma during the 8-year follow-up period. The incidence of cholesteatoma per 1000 person-years was more than twice as high among patients with CRS (0.65; 95% CI, 0.50-0.81 person-years) than among those without CRS (0.28; 95% CI, 0.24-0.33). The absolute difference in the incidence density between CRS and non-CRS group was 0.37 (95% CI, 0.21-0.53) per 1000 patient-years. After adjusting for potential confounders, patients with CRS had a 69% increased risk of cholesteatoma within 8 years, compared with those without CRS (HR, 1.69; 95% CI, 1.23-2.32). Patients with CRS presented a significantly lower 8-year cholesteatoma-free survival rate than did those in the comparison group. The absolute difference in the 8-year cholesteatoma-free survival rate between the CRS and non-CRS groups was 0.0029 (95% CI, 0.0016-0.0043). This is the first large-scale study, to date, to demonstrate a prospective link between CRS and the subsequent development of cholesteatoma within a follow-up period of 8 years. The purpose of the study was to draw attention to the possibility of development of cholesteatoma among patients with CRS. Because that possibility exists, clinicians should keep this association in mind as well as the importance of a thorough head and neck examination.

Incidence, 10-year recidivism rate and prognostic factors for cholesteatoma

Cholesteatoma patients have a high risk of recurrence with complications, and knowledge exchange is a prerequisite for improving treatment. This study aimed to apply appropriate statistics to provide meaningful and transferable results from cholesteatoma surgery, to highlight independent prognostic factors, and to assess the incidence rate. Incidence rates were assessed for the district of Aarhus, Denmark. From 147 patients operated on mainly with canal wall up mastoidectomies for debuting cholesteatomas, 10-year Kaplan-Meier recidivism rates were calculated and independent prognostic factors for the recidivism were identified by Cox multivariate regression analyses. Incidence rate was 6.8 per 100 000 per year. The 10-year cumulative recidivism rate was 0.44 (95 per cent confidence interval, 0.37-0.53). Independent prognostic factors for the recidivism were: age below 15 years (hazard ratio = 2.2; p > z = 0.002), cholesteatoma localised to the mastoid (hazard ratio = 1.7; p > z = 0.04), stapes erosion (hazard ratio = 1.9; p > z = 0.02) and incus erosion (hazard ratio = 1.9; p > z = 0.04). The recidivism rate is influenced by several factors that are important to observe, both in the clinic and when comparing results from surgery.

Cytokeratin 13, Cytokeratin 17, and Ki-67 Expression in Human Acquired Cholesteatoma and Their Correlation With Its Destructive Capacity.

Objectives Cholesteatoma is a nonneoplastic destructive lesion of the temporal bone with debated pathogenesis and bone resorptive mechanism. Both molecular and cellular events chiefly master its activity. Continued research is necessary to clarify factors related to its aggressiveness. We aimed to investigate the expression of Ki-67, cytokeratin 13 (CK13) and cytokeratin 17 (CK17) in acquired nonrecurrent human cholesteatoma and correlate them with its bone destructive capacity.Methods A prospective quantitative immunohistochemical study was carried out using fresh acquired cholesteatoma tissues (n=19), collected during cholesteatoma surgery. Deep meatal skin tissues from the same patients were used as control (n=8). Cholesteatoma patients were divided into 2 groups and compared (invasive and noninvasive) according to a grading score for bone resorption based upon clinical, radiologic and intraoperative findings. To our knowledge, the role of CK17 in cholesteatoma aggressiveness was first investigated in this paper.Results Both Ki-67 and CK17 were significantly overexpressed in cholesteatoma than control tissues (P<0.001 for both Ki-67 and CK17). In addition, Ki-67 and CK17 were significantly higher in the invasive group than noninvasive group of cholesteatoma (P=0.029, P=0.033, respectively). Furthermore, Ki-67 and CK17 showed a moderate positive correlation with bone erosion scores (r=0.547, P=0.015 and r=0.588, P=0.008, respectively). In terms of CK13, no significant difference was found between cholesteatoma and skin (P=0.766).Conclusion Both Ki-67 and CK17 were overexpressed in cholesteatoma tissue and positively correlated with bone resorption activity. The concept that Ki-67 can be a predictor for aggressiveness of cholesteatoma was supported. In addition, this is the first study demonstrating CK17 as a favoring marker in the aggressiveness of acquired cholesteatoma.

Surgery for Chronic Otitis Media Causes Greater Taste Disturbance Than Surgery for Otosclerosis.

Patients with otosclerosis more often complain about postoperative taste disturbance than patients with chronic otitis media, which seems paradoxical. We aim to investigate if and potentially why this seems to be the case, since the chorda tympani nerve (CTN) is thought to be severely traumatized less frequently during surgery in the former than in the latter. Prospective cohort study. Department of Otorhinolaryngology at Hospital of Vastmanland, Vasteras, Sweden. Sixty-five adults undergoing primary middle ear surgery were included. Thirty-seven were operated on for chronic suppurative otitis media with or without cholesteatoma (CSOM) and 28 for otosclerosis. Middle ear surgery due to otosclerosis or CSOM. Subjective and objective taste measurements and quality of life (QoL) questionnaire. Taste was assessed using electrogustometry (EGM) and the filter paper disc (FPD) method before and up to 1 year after surgery. Questionnaires on taste disturbance, including a visual analogue scale (VAS), and QoL were completed before and up to 1 year after surgery. Subjective taste disturbance anytime during the 1-year follow-up were reported by 62 and 46%, respectively. The difference in EGM 1 week after surgery compared with preoperative EGM was significantly greater among CSOM patients than otosclerosis. One year postoperatively, the difference is non-significant. Surgery for CSOM causes greater initial and more long-lasting taste disturbances as compared with surgery for otosclerosis. One-year postoperative taste normalizes for both CSOM and otosclerosis patients according to VAS and EGM measurements. No real change in QoL was seen 1-year postoperatively. Level 2 evidence is prospective observational research with an experimental design.

Increased Risk of Depression in Patients with Cholesteatoma: A 3-year Nationwide Population-Based Retrospective Cohort Study

Newly discovered epidemiological evidence linking cholesteatoma to depression suggests that routine screening and monitoring of psychological status among cholesteatoma patients is warranted. Policies aimed at the early detection and timely treatment of comorbid depression following diagnosis with cholesteatoma could enhance health promotion and disease prevention.

The accuracy and sensitivity of diffusion-weighted magnetic resonance imaging with Apparent Diffusion Coefficients in diagnosis of recurrent cholesteatoma

ObjectiveTo evaluate the accuracy and sensitivity of diffusion-weighted magnetic resonance imaging with ADC value combined with MDCT in evaluating recurrent cholesteatoma. PatientsThirty patients (20 females and 10 males), their age ranged from 10 to 40years, had undergone a tympanomastoid surgery for a cholesteatoma of the middle ear underwent MDCT and MR DWI examination before second- or third-look surgery from May 2015 to October 2016. ResultsCT showed partial opacification of the tympanomastoid cavity in 10 ears and complete opacification in 21 ears. CT detects 10 cases out of 20 cases of recurrent cholesteatoma with sensitivity 47.6%, specificity 100%, and NPP 47.6%. DWI depicted 21 out of 20 cases proved cholesteatoma patients (sensitivity 100%, specificity 90%, PPV 95.2% and P value is 0.001). All MRI of patients without cholesteatoma were correctly interpreted as showing negative findings for cholesteatoma (specificity=100%). The ADC of cholesteatoma group (21 ears) were ranged from 553 to 759×10−3mm2/s and the ADCs of non cholesteatoma group (10 ears) was ranged from 1495.8 to 1766.8×10−3mm2/s. Cut off value of cholesteatoma is ≤759×10−3mm2/s. ConclusionMR DWI with ADC combined with MDCT has high sensitivity, specificity, accuracy in detecting recurrent cholesteatoma.

Cholesteatoma of Maxillary Sinus: What Is the Best Surgical Approach?

Cholesteatoma is a relatively common disease entity within the middle ear or mastoid cavity but cholesteatoma of the paranasal sinuses is a rare diseases entity, especially in the maxillary sinus. As the authors recently experienced a patient of maxillary sinus cholesteatoma, the authors tried to review all the literatures previously reported on the "Cholesteatoma of the maxillary sinus." The aim of this study was to describe authors' recent experience and review previously reported patients of cholesteatoma of the maxillary sinus. Additionally, it is to describe the clinical features focusing on the computed tomography findings and to elucidate which approach may be best for complete excision. The authors thoroughly reviewed 10 patient reports written in English regarding the cholesteatoma of maxillary sinus which have been published since the 1980s. Based on authors' review, the authors suggest some conclusions. First, the diagnosis of cholesteatoma, although rare, should be considered for any slowly expansile lesion of the maxillary sinus. Second, there was no specific computed tomography finding that was helpful for the diagnosis of maxillary sinus cholesteatoma. Last, the surgical approach to cholesteatoma of the maxillary sinus should be chosen to allow visibility and complete removal according to the size, location, and extent of diseases.

Characteristics of 419 patients with acquired middle ear cholesteatoma

IntroductionCholesteatoma is a destructive lesion that can result in life-threatening complications. Typically, it presents with hypoacusis and continuous otorrhea as symptoms. Because it is a rare disease, there are few studies in Brazil describing the characteristics of patients with the disease. ObjectiveThis study aimed to determine the prevalence of cholesteatoma in patients with chronic otitis media and describe clinical, audiological and surgical characteristics of patients with acquired middle ear cholesteatoma treated at a referral hospital in the public health system. MethodsCross-sectional and prospective cohort study, including 1710 patients with chronic otitis media, treated between August 2000 and June 2015, without prior surgery. Detailed clinical history, videotoscopy, and audiometry were performed, in addition to review of medical records to search for surgical data. Cholesteatomas were classified according to their route of formation. ResultsOf the patients with chronic otitis media, 419 (24.5%) had cholesteatoma; mean age of 34.49 years; 53.5% female and 63.8% adults. Bilateral cholesteatoma was observed in 17.1%. Anterior epitympanic cholesteatoma corresponded to 1.9%; posterior epitympanic, 32.9%; posterior mesotympanic, 33.7%; two routes, 14.8%; and indeterminate, 16.7%. The mean air-bone gap was 29.84dB and did not differ between routes of formation. There were no correlations between gap size and patient age or duration of symptoms. Of the surgical cases, 16.8% underwent closed tympanomastoidectomy and 75.2% open tympanomastoidectomy. ConclusionThe prevalence of cholesteatoma in patients with chronic otitis media was 24.5% and it was more common in adults than in children. Posterior mesotympanic cholesteatoma was more frequent, with no difference in mean air-bone gap between the different routes of formation. In patients undergoing surgery, open tympanomastoidectomy was the procedure most frequently chosen.

Incidence of mastoidectomy among cholesteatoma patients in Denmark

Incidence of mastoidectomy among cholesteatoma patients in Denmark

Analyses of the operative efficacy of 102 cases of acquired middle ear cholesteatoma

To investigate the efficacy of operations of acquired middle ear cholesteatoma. Retrospectively analyzed clinical data of 102 patients whom received tympanoplasty with CWU or CWD with mastoid obliteration in our hospital between January 2014 and December 2014. Patients were divided into different groups according to types of the cholesteatoma as well as the different surgical procedures. Patients were followed up for 12-24 months, the pre and post-operative PTA was performed and evaluated. The post-operative hearing was assessed in terms of average ABG. The average dry ear time was (5.4±1.7)weeks. The dry ear time of patients of attic cholesteatoma was shorter than those of tensa cholesteatoma[(4.9±1.7)weeks vs(6.1±1.5)weeks, t=-3.52, P=0.001]; the dry ear time of patients underwent CWU was shorter than those underwent CWD with mastoid obliteration[(2.3±0.5)weeks vs(5.8±1.4)weeks, t=-8.43, P=0.000]. Mean pre and post-operative air bone gaps in 93 ears underwent ossiculoplasty were (34.2±11.8)dB and (19.0±5.5)dB respectively and these differences were statistically significant. Both the pre and post-operative air bone gaps of ears of attic cholesteatoma were smaller than those ears of tensa cholesteatoma(P<0.05). In the patients who underwent ossiculoplasty with CWD with mastoid obliteration, the post-operative air bone gaps of attic cholesteatoma were smaller than those of tensa cholesteatoma(P<0.05). Both the pre and post-operative air bone gaps of ears underwent CWU were smaller than those underwent CWD with mastoid obliteration(P<0.05). The post-operative air bone gaps of ears underwent PORP with CWD with mastoid obliteration were smaller than those underwent TORP with CWD with mastoid obliteration(P<0.05). Both the hearing loss and the outcome of tensa cholesteatoma are worser than attic cholesteatoma. The outcome of PORP is better than TORP. The patients who will accept CWU should be selected more carefully and be followed up regularly.

Canal wall up surgery for cholesteatoma patients. When and how to perform ossicular reconstruction

Canal wall up surgery for cholesteatoma patients. When and how to perform ossicular reconstruction

Contemporary clinical features of Cholesteatoma

Chronic Otitis media with Cholesteatoma is a destructive lesion of middle ear and mastoid region. In a series of 122 patients with established diagnosis of atticoantral disease, clinical characteristics of consecutive 74 patients with cholesteatoma otitis media were compared with 48 patients with chronic otitis media without cholesteatoma (Controls).The patients answered a questionnaire, preoperative and perioperative clinical observations were recorded. There were no specific presenting symptoms or clinical signs that could distinguished the cholesteatoma patients. However, these patients had a significantly higher incidence (32%) of previous middle ear surgery than the control patients (18%). Aural bleeding was reported in higher number in controlled cases (8.5%) as compare to cholesteatoma cases (1.3%). Pars flaccida perforation was noted in 94 % (80% isolated) in cholesteatoma patients. Extracranial complications e.g. mastoid abscess, postaural fistula, mastoiditis and otitis externa was note in 6.7% and 4% respectively in cholesteatoma and control group. The percentage of labyrinthitis and facial nerve affection was 11% and 4.1% in cholesteatoma cases respectively against 6% and 2% in control group. The cholesteatoma was not evident until the time of surgical exploration in as many as 28% of cases. Therefore surgical exploration appears to be the reliable and safest way to identify cholesteatoma.

Depression and cholesteatoma: Preliminary findings from a nationwide population-based retrospective cohort study

ObjectiveTo estimate the risk of developing depressive disorder (DD) following diagnosis with cholesteatoma. MethodsIn the study, we analyzed data from the Longitudinal Health Insurance Database of Taiwan. A total of 599 patients newly diagnosed with cholesteatoma between 1997 and 2007 were included with a comparison cohort of 2995 matched non-cholesteatoma enrollees. Each patient was followed for 3 years to identify the subsequent development of DD. Cox proportional hazard regression analysis was performed to compute adjusted 3-year hazard ratios. ResultsThe incidence of DD per thousand person-years was approximately twice as high among patients with cholesteatoma (11.32) as among those without cholesteatoma (5.85). After adjusting for potential confounders, patients with cholesteatoma were 1.99 times (95% CI=1.18–3.34, P=0.010) more likely to suffer from DD within 3 years compared to those without cholesteatoma. ConclusionsThis is the first study to demonstrate a link between cholesteatoma and subsequent DD within a three-year followup. We suggest that clinicians keep this critical but neglected issue in mind and carefully investigate the possibility of subsequent psychological problems among cholesteatoma patients.

Canal Wall down Mastoidectomy and Tympanoplasty in Cholesteatoma Surgery: Ten Years’ Experience

Tympanomastoid surgery for cholesteatoma is a procedure designed to eliminate the disease and maintain a safe and dry ear. This retrospective study was designed to evaluate the functional results of cholesteatoma patients who underwent canal wall down mastoidectomy in conjunction with a tympanoplasty. Operated ears due to chronic otitis media with cholesteatoma were considered for the study. The study was carried out in 120 ears. The choice of technique for tympanoplasty is based on the pathology encountered in the stapes superstructure. Patients were divided into three: 1) Group A, a type II TPL with stapes columella reconstruction; 2) Group B, a type III TPL with major columella reconstruction; and 3) Group C, a type IV TPL using a temporalis fascia and thick cartilage to shield the round window. The operated ears of Groups A and B, as compared to Group C, presented a significant decrease in the pre-operative Air-bone gap and an increase in the number of operated ears with an Air-bone gap between 0 - 20 dB. The study emphasizes the importance of functional separation of the two acoustic windows by fascia and cartilage graft when the stapes superstructure is missing but the footplate is mobile.

Synchronous Ossiculoplasty with Ossicular Replacement Prosthesis during Canal Wall Down Mastoidectomy for Advanced Cholesteatoma: Anatomical and Audiological Outcomes

ABSTRACT Objectives To evaluate the anatomical and audiological outcomes of synchronous ossiculoplasty with ossicular replacement prosthesis during canal wall down mastoidectomy for advanced cholesteatoma. Methods The prospective study was done at a tertiary referral institute included 30 patients of cholesteatoma who underwent canal wall down mastoidectomy. Ossicular reconstruction was performed using polytetrafluoroethylene (PTFE) (teflon) partial or total ossicular replacement prosthesis. Patients were assessed at 1st, 3rd and 6th postoperative months for graft uptake and hearing evaluation using pure tone audiometry (PTA) in which air bone gap (ABG) closure and mean ABG was calculated and compared with the mean preoperative ABG. Results The mean ABG [both total occicular replacement prosthesis (TORP) and partial occicular replacement prosthesis (PORP) groups combined] considerably reduced from 34.33 ± 4.10 dB preoperatively to 15.47 ± 7.65 dB postoperatively at 6 months. There was a 46.29% of closure of ABG in 1st month, which closed more (53.89%) in 3rd month and even more (55.34%) in 6th postoperative month. p &lt; 0.001 showed the ABG closure ratio and reduction in the mean ABG was statistically significant in the postoperative period. Conclusion Ossicular reconstruction with ossicular replacement prosthesis offers good functional results when performed during canal wall down surgery for advanced cholesteatoma, as a single-stage procedure. How to cite this article Shareef M, Motwani G, Verma D, Malik NUD, Choudhary SR. Synchronous Ossiculoplasty with Ossicular Replacement Prosthesis during Canal Wall Down Mastoidectomy for Advanced Cholesteatoma: Anatomical and Audiological Outcomes. Int J Otorhinolaryngol Clin 2015;7(3):109-113.