Cholesteatoma Patients Research Articles

Gustatory Function of Patients With and Without Cholesteatoma Undergoing Middle Ear Surgery.

To compare measured and perceived taste function before and after surgery of patients with chronic otitis media with cholesteatoma (OMCC) to patients without cholesteatoma (patients with chronic suppurative otitis media [CSOM] and patients with lateral skull base lesions [LSB]). This prospective cohort study included 29 patients undergoing surgery for unilateral OMCC. The chorda tympani nerve (CTN) was resected in 8 of these patients. Fourteen patients undergoing surgery for unilateral CSOM and 5 patients undergoing surgery for unilateral LSB (with CTN resection) served as the comparison group. Taste function was measured using taste strips on both sides of the tongue before surgery, 2 weeks postoperatively and 3 months postoperatively. The affected side of the tongue was compared to the unaffected side. A questionnaire on taste perception was completed at each visit. Preoperatively, cholesteatoma patients showed higher taste strip scores than non-cholesteatoma patients, indicating a larger difference between the healthy and affected sides of the tongue. Despite this difference in measured taste function few cholesteatoma patients reported taste alteration before surgery (3/29 [10.3%]). Postoperatively, patients with CTN resection (OMCC patients with CTN resection and LSB patients) showed a decreased measured taste function. Subjectively, only approximately 20% of these patients reported taste alteration 3 months postoperatively. Before surgery, cholesteatoma patients displayed an impaired measured taste function compared to patients without cholesteatoma (CSOM, LSB). Subjectively this was often unnoticed. After surgery, despite removal of the CTN and consequent reduction of measured taste function, few patients reported taste alteration and subjective taste perception was seen to be improving. In regards to middle ear surgery, perceived taste function does not seem to reflect measured gustatory function.

A retrospective study of audiological outcomes after endoscopic tympanoplasty and tympanomastoidectomy in patients with cholesteatoma

ObjectivesTo investigated whether endoscopic tympanoplasty and tympanomastoidectomy could present satisfying audiological outcomes for cholesteatoma patients. MethodsThis was a retrospective study of 83 patients with cholesteatoma who underwent endoscopic tympanoplasty and tympanomastoidectomy between 2019 and 2021. The preoperative and postoperative audiological evaluations were performed. The evaluation methods included air conduction (AC), bone conduction (BC), and air-bone gap (ABG) procedures. ResultsEighty-three patients were included in the study, all of whom underwent endoscopic tympanoplasty and tympanomastoidectomy. Forty-seven patients presented postoperative ABG≤20 dB (59.49%). The frequencies tested included low-frequency (LF), middle-frequency (MF), high-frequency (HF), and pure-tone average (PTA). All three audiological parameters significantly decreased after surgery (P < 0.05) at every frequency, except for BC-LF (P > 0.05). There were also significant differences between the preoperative and postoperative proportions of degree of hearing (P < 0.05). Additionally, shifts in AC, BC, and ABG were linearly related to preoperative AC, BC, and ABG. Lastly, postoperative ABG-PTA presented differently depending on preoperative stapes superstructure conditions (present: 15.81 ± 11.23 dB, absent: 22.94 ± 12.20 dB, P = 0.009). ConclusionsOur study of endoscopic tympanoplasty and tympanomastoidectomy presented complete audiological outcomes for cholesteatoma patients. It had a positive surgery success rate and improved AC, BC, and ABG at every frequency except BC-LF. Additionally, AC-LF and AC-MF improved to a greater degree than AC-HF due to these procedures. Moreover, the linear regression analyses demonstrated that preoperative ABG-PTA was the most efficient audiological indicator for surgery. Likewise, the preoperative condition of the stapes superstructure was proved to be the most efficient anatomical indicator for hearing outcomes.

A comparative analysis of canal wall reconstruction mastoidectomy over canal wall down mastoidectomy

AimThis study aims to investigate the advantages of canal wall reconstruction mastoidectomy (C.W.R.) over the canal wall down (CWD) mastoidectomy.Material and methodA prospective study was conducted on sixty patients with cholesteatoma who underwent operation from September 2010 to October 2016. Patients were divided into two groups: “Group A," posterior canal wall reconstruction group (C.W.R.) with 28 patients (28 ears) and “Group B” which included 32 patients (32 ears) in whom canal wall down mastoidectomy (CWD) was done without reconstruction. The patients were followed up at 3 months and 6 months postoperatively with otoendoscopy to look for recurrence or residual disease, the occurrence of any complications, and for hearing assessment.ResultsGroup A (C.W.R.) patients were cosmetically better, and none had postoperative cavity problems. While in Group B (CWD), 16 patients (50%) had a cavity problem. Group A CWR group also had early epithelization. Both methods had hearing improvement postoperatively. Group A had more hearing improvement than Group B.ConclusionThe C.W.R. method is a safe method for eliminating the problem of the mastoid cavity. This surgery can be easily taught and applied universally in all cholesteatoma patients as a primary treatment. The C.W.R. technique provides improved exposure to the middle ear without creating a mastoid bowl, which significantly reduces the incidence of residual and recurrent disease. These results indicate that the C.W.R. method is better than the CWD operation.

Variability of the retrotympanum and its association with mastoid pneumatization in cholesteatoma patients

PurposeThis study aimed to investigate the variability of the retrotympanum in patients undergoing surgical treatment for cholesteatoma.MethodsWe included 59 ears of patients undergoing middle ear surgery for cholesteatoma who had preoperative computed tomography scans. A retrospective analysis of the medical records was conducted. The sinus tympani (ST), subtympanic sinus (STS) and facial recess (FR) were classified into types A–C based on the relationship of their extension to the facial nerve. The mastoid and petrous apex were assessed and categorized as normal pneumatized or sclerotic.ResultsType A extension was the most frequently found in all sinuses (ST 64%, FR 77%, STS 69%), Type B extension was found more often in ST (34%) and STS (24%) than in FR (15%). A very deep extension was found only rarely (ST 2%, FR 8%, STS 7%). A sclerotic mastoid was found in 67% of cases. Those cases showed a statistically significant difference regarding retrotympanum pneumatization when compared with normal mastoid.ConclusionThe most frequent variant of retrotympanic pneumatization in relation to the facial nerve was type A in all subsites in cholesteatoma patients. The variability among patients with cholesteatoma is different to previously published results in healthy subjects. Moreover, the pneumatization of the retrotympanum is associated with mastoid pneumatization.

Postoperative Patient Reported Outcomes After Cholesteatoma Surgery.

Results and success measures of cholesteatoma surgery are generally described using objective data whereas subjective data are mostly lacking. Patients experiences and complaints are becoming more important alongside clinical and audiometric outcome measures in cholesteatoma care. To investigate the course of patient-reported complaints, the impact of complaints, audiometric measures and the stability of audiometric measures, and complaints over time after primary and recurrent/residual cholesteatoma surgery. Postoperative patients were prospectively included and divided into primary acquired and recurrent/residual cholesteatoma. The EuroQol 5D (EQ-5D-3L), Otology Questionnaire Amsterdam (OQUA), and the Speech Spatial Questionnaire (SSQ) were completed by 144 patients up to 2 years postoperative. Patient-reported complaints divided in eight separate domains, postoperative hearing and impact on daily life were longitudinally assessed by means of linear mixed models. Hearing loss and tinnitus are the most reported postoperative complaints over time. Patient-reported loss of taste and the impact of all complaints decline over time. All other patient-reported complaints remain stable over time, only itch complaints fluctuate. Primary cholesteatoma patients score significantly higher on hearing loss complaints compared with recurrent/residual patients although they have comparable mean audiometric hearing loss. Furthermore, pure-tone hearing threshold, instead of asymmetric hearing loss, is correlated with the localization domain of the SSQ. This study provides important insights in the course of complaints and its impact on daily life after cholesteatoma surgery. Overall, the postoperative patient-reported complaints after cholesteatoma surgery are generally low in the studied population.

Labyrinthine Fistula in Cholesteatoma Patients: Outcomes of Partial Labyrinthectomy With "Underwater Technique" to Preserve Hearing.

Labyrinthine fistula (LF) is one of the most important complications of cholesteatoma and is defined as an abnormal communication between the inner and the middle ear. This study aims to describe our experience with the partial labyrinthectomy evaluating the post-operative hearing results. Twenty-one patients who presented labyrinthine fistula in the semicircular canals were included in the present study. Hearing impairment was present in 48% of patients (10/21). A pre-operative assessment using the Gardner–Robertson hearing classification showed the following: 52%, Class I; and 48%, Class II. A post-surgical Gardner–Robertson hearing classification evidenced the following: 43%, Class I; and 57%, Class II. The presence of LF is usually considered a negative prognostic factor for hearing preservation. The key point of partial labyrinthectomy surgery is the preservation of structures, keeping them wet with Ringer's solution throughout the procedures, and not performing suction that is close to the opened LF. The bony labyrinth is drilled underwater without suction, removing the entire cholesteatoma matrix and quickly plugging the site before and after the LF. This faster plugging of the labyrinth makes it possible to preserve the peri-lymph and the endo-lymph fluid and the hearing function. This study showed that a partial labyrinthectomy is useful for maintaining serviceable hearing in patients with LF.

An Effective Method to Collect Bone Dust for Mastoid Cavity Obliteration.

To compare the volume of cortical bone dust collected and the time taken for bone dust collection by using a self-devised bone dust collector and that by manual method using a metal scoop in patients undergoing modified radical mastoidectomy with mastoid cavity obliteration. A prospective study was done in 62 patients of cholesteatoma. They underwent canal wall down mastoidectomy. Mastoid cavity was obliteration was done using cortical bone dust collected after dividing the patients randomly into 2 groups: (1) usinga collector device made using a mucous extractor fitted with a nylon mesh of size 1″ × 3″attached to the suction tube, (2) collected manually by using a metal scoop. The time taken for the collection of bone dust was recorded and the volume of bone dust collected was measured and recorded. We found that the time taken for the collection of bone dust was significantly lower and the volume of bone dust collected was higher using a mucous extractor as compared to that by manual collection using a metal scoop. The suction based mucous extractor performed better in terms of both time taken for collection and also in the volume of cortical bone dust that was collected as compared to manual collection using a metal scoop. Therefore, we conclude from our study that using the suction based mucous extractor is a more effective method of cortical bone dust collection for mastoid cavity obliteration.

CHOLESTEATOMA PRESENTATION TRENDS IN KOHAT DIVISION

Objective: To discuss the presentation stages of Cholesteatoma in patients of various areas of Kohat division.&#x0D; Study Design: Case series study.&#x0D; Place and Duration of Study: Combined Military Hospital Kohat, from Nov 2015 to Nov 2017.&#x0D; Methodology: A total of 60 patients having Chronic Suppurative otitis media with Cholesteatoma were selected from outpatient department. Disease process was evaluated by otomicroscopy as well as radiologically. Perioperative disease spread pattern was also assessed and documented.&#x0D; Results: Out of 28 patients with pars tensa cholesteatoma 28.5% were in stage II and 53.5% were in stage III disease. Out of 32 patients with pars flaccid cholesteatoma, 3.1% presented with stage 1 disease, 37.5% with stage II disease, 50% with stage III disease and 9.3% with stage IV disease.&#x0D; Conclusion: Appropriate measures should be taken for training of general physicians as well as otologists at National level to help early diagnosis and better outcome.

RhoA, ROCK-1, and ROCK-2 Gene Expression and Polymorphisms in Cholesteatoma Patients.

Background: The aim of this study was to evaluate the gene polymorphism and expressions of Rho-A, ROCK-1, and ROCK-2 in cholesteatoma.Methods: In this study, 120 healthy control group patients and 120 cholesteatoma patients were enrolled. Venous blood was taken from all of the cholesteatoma and control group patients. The genotyping of ROCK-1(G/T)rs35996865, ROCK-2(A/C)rs10178332, and Rho-A(A/T)rs2177268 polymorphisms was performed using predesigned TaqMan SNP Genotyping Assays. Assays-on-Demand SNP genotyping kit was used for the real-time polymerase chain reaction. The expression levels of Rho-A(Hs00357608_m1), ROCK-1(Hs01127699_m1), and ROCK-2(Hs00178154_m1) genes were determined.Results: The expression of Rho-A, ROCK-1, and ROCK-2 was lower in cholesteatoma patients than in the control group. There was no difference in Rho-AAT/TT and ROCK-1GT/TT variation in cholesteatoma patients compared to the control. However, ROCK-2 AC/CC variance was lower in cholesteatoma patients.Conclusion: The expression of Rho-A, ROCK-1, and ROCK-2 genes may be decreased in cholesteatoma. Furthermore, since ROCK-2 AC/CC genotype is also lower in cholesteatoma, having C allele seems to decrease the risk of developing this disease.

Early non-EPI DW-MRI after cholesteatoma surgery.

Middle ear cholesteatoma may lead to the erosion of the bony structures of the temporal bone, possibly causing intra- and extracranial complications. Surgical treatment is mandatory, and due to possible residual/recurrent disease, the use of reliable diagnostic methods is essential. Our study aimed to evaluate the reliability of non-EPI DW-MRI for the follow-up of cholesteatoma after surgery. In a study group including 53 consecutive patients who underwent surgery for cholesteatoma at a tertiary university hospital, an imaging protocol was applied, including non-echo planar diffusion-weighted imaging magnetic resonance (MR) at 1month after surgery and then at 6 and 12months after surgery. Based on the combination of preoperative assessment and intraoperative findings, the study group was divided into 3 subgroups: petrous bone (PB) cholesteatoma, complicated cholesteatoma and uncomplicated cholesteatoma. PB cholesteatoma patients were treated by a subtotal petrosectomy, whereas complicated and uncomplicated cholesteatoma patients were treated either by a canal wall up procedure or a retrograde (inside-out) canal wall down technique with bone obliteration technique (BOT). The results show that patients who had positive findings on non-EPI DW-MRI scans 1month after surgery consequently underwent revision surgery during which residual cholesteatoma was noted. All the patients who displayed negative findings on non-EPI DWI-MRI scan at 1 month after surgery did not show the presence of a lesion at the 6- and 12-month evaluations. The 6 patients who displayed residual cholesteatoma at the 1-month follow-up presented dehiscence/exposure of the facial nerve canal at the primary surgery, mostly at the level of the labyrinthine segment. Non-EPI DW-MRI is a useful and reliable tool for follow-up cholesteatoma surgery, and when applied early, as was done in the protocol proposed in the present study, this tool may be used to detect the presence of residual cholesteatoma in some patients, prompting the planning of early revision surgery.

Cholesteatoma Is Associated With Pediatric Progressive Sensorineural Hearing Loss.

This study identified an association between cholesteatoma and progressive sensorineural hearing loss using a large pediatric longitudinal audiologic dataset. Cholesteatoma is a potential sequela of chronic otitis media with effusion, a commonly observed auditory pathology that can contribute to hearing loss in children. The purpose of this report is to (i) describe the process of identifying the association between cholesteatoma and progressive sensorineural hearing loss in a large pediatric dataset and (ii) describe the audiologic data acquired over time in patients identified with cholesteatoma-associated progressive sensorineural hearing loss. Records of patients included in the Audiologic and Genetics Database (n = 175,215 patients) were examined using specified criteria defining progressive hearing loss. A linear regression model examined the log frequency of all diagnostic codes in the electronic health record assigned to patients for a progressive hearing loss cohort compared with a stable hearing loss group. Based on findings from the linear regression analysis, longitudinal audiometric air (AC) and bone conduction (BC) thresholds were extracted for groups of subjects with cholesteatoma-associated progressive (n = 58 subjects) and stable (n = 55 subjects) hearing loss to further analyze changes in hearing over time. The linear regression analyses identified that diagnostic codes for cholesteatoma were associated with progressive sensorineural hearing loss in children. The longitudinal audiometric data demonstrated within-subject changes in masked BC sensitivity consistent with progressive sensorineural hearing loss in children diagnosed with cholesteatoma. Additional analyses showed that mastoidectomy surgeries did not appear to contribute to the observed progressive hearing loss and that a high number of cholesteatoma patients with progressive hearing loss had normal-hearing thresholds at their first test. The statistical analyses demonstrated an association between cholesteatoma and pediatric progressive sensorineural hearing loss. These findings inform clinical management by suggesting that children with cholesteatoma diagnoses may be at increased risk for progressive sensorineural hearing loss and should receive continued monitoring even after a normal masked BC baseline has been established.

Bacterial and Fungal Infections Promote the Bone Erosion Progression in Acquired Cholesteatoma Revealed by Metagenomic Next-Generation Sequencing.

An acquired cholesteatoma generally occurs as a consequence of otitis media and eustachian tube dysfunction. Patients with acquired cholesteatoma generally present with chronic otorrhea and progressive conductive hearing loss. There are many microbes reportedly associated with acquired cholesteatoma. However, conventional culture-based techniques show a typically low detection rate for various pathogenetic bacteria and fungi. Metagenomic next-generation sequencing (mNGS), an emerging powerful platform offering higher sensitivity and higher throughput for evaluating many samples at once, remains to be studied in acquired cholesteatoma. In this study, 16 consecutive patients from January 2020 to January 2021 at the Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU) were reviewed. We detected a total of 31 microbial species in patients, mNGS provided a higher detection rate compared to culture (100% vs. 31.25%, p = 0.000034). As the severity of the patient’s pathological condition worsens, the more complex types of microbes were identified. The most commonly detected microbial genus was Aspergillus (9/16, 56.25%), especially in patients suffering from severe bone erosion. In summary, mNGS improves the sensibility to identify pathogens of cholesteatoma patients, and Aspergillus infections increase bone destruction in acquired cholesteatoma.

The role of Grafting in Canal Wall down Mastoidectomy Comparative Study

Background: Radical mastoidectomy is the outstanding standard technique for management of cholesteatoma. Long term studies showed increasing incidence of discharging cavities . Modified radical mastoidectomy was described to prevent recurrent cholesteatoma along with reconstruction of the ossicular hearing mechanismre. Exteriorization of the disease bearing areas is essential for effective follow up. However, there are many recesses which cannot be exteriorized regarding its anatomical location such as the mesotympanum. It will be a source of discharge or accumulation of keratin. Covering these recesses by grafting is an essential rather than optional step in all radical mastoidectomies to prevent problematic cavities. Aim of work: Demonstrate the necessity of grafting in radical mastoidectomy for obtaining dry cavity. Patients and methods: A prospective, comparative study conducted from March 2016 to October 2019 on 60 cholesteatoma patients. Patients were randomized into 2 equal groups of 30 patients each. In group A, patients undergone modified radical mastoidectomy with grafting, while patients in group B have undergone radical mastoidectomy without grafting. Regular follow up was done monthly for 1 year for both groups.Results: In group A, 22 patients have intact grafts, and dry well epithelialized cavities, 2 patients had perforated grafts, 5 patients had small discharging granulations and 1 patient had a keratin pearl under the graft. In group B, 19 patients suffered persistent discharging cavity , 8 patients had less discharge with keratin debris and granulations and 3 patients had dry cavities. Conclusion: Grafting is an essential step in radical mastoidectomy to prevent cavity problems.

Medially-invasive cholesteatoma

Cholesteatoma is life-threatening disease due to its intracranial complications. Some of cholesteatoma cases we define as aggressive cholesteatoma. In this category we include children cholesteatoma, medially-invasive cholesteatoma and petrous apex cholesteatoma which does not originate in the petrous apex. Another special form of cholesteatoma is petrous bone cholesteatoma. Retrospective study of 176 cholesteatoma operations (38.85%) from 453 consecutive middle ear surgeries for 4 years and 4 months in Trakia Park Hospital Stara Zagora, Bulgaria were rewieved. The same surgeon performs 106 Primary Cholesteatoma Surgery, 49 Revision Surgery and 21 Second-Look Surgery. In this 176 cholesteatoma cases the cholesteatoma matrix involve the otic capsule, petrous apex or skull base in 5 patients, who are defined as medially-invasive cholesteatoma (2.84%). In this medially-invasive cholesteatoma patients surgical resection with canal wall down operation remains the best treatment option.

The chronic ear: A case report of bilateral cholesteatoma in a 10-year-old boy

&#x0D; Cholesteatoma is a rare condition affecting 9-12.6 adults and 3-15 children per 100,000 per annum [1–4], with a more aggressive presentation in the paediatric population [5].&#x0D; Intermittent otorrhea (ear discharge) is the presenting complaint in over half of cholesteatoma patients [6, 7]. The peak incidence of cholesteatoma is 5-15 years of age [8] which overlaps significantly with a period of high incidence in otitis media [9] and externa [10], diseases that often present the same way as cholesteatoma. This results in diagnosis that may take several years.&#x0D; Left untreated, cholesteatoma can cause significant lasting damage in the form of deafness, vertigo, facial paralysis, meningitis, and brain abscesses which may prove fatal [11].&#x0D; Current treatment options are limited to surgical excision with the aim to establish a safe and manageable ear, while maintaining hearing is secondary. Improving surgical instrumentation has allowed a better success rate, however, revision surgeries remain a mainstay of practice. In practical terms, this means that those affected by bilateral disease often undergo surgery 4 or more times [12]. This represents a significant burden for patients.&#x0D; The decision about the exact surgical approach (canal wall up vs canal wall down) is a careful balancing act of safety versus functionality, and the pros and cons must be weighed in light of available evidence and the skill of the surgeon [13].&#x0D;

Differential Expression of Ki-67 and P27 in Cholesteatoma Compared to Skin Tissue Predicts the Prognosis of Adult Acquired Cholesteatoma.

Background: The aim of this study was to compare the differential Ki-67 and p27 staining properties of acquired cholesteatoma in adult patients for prognostic analysis.Methods: Forty-two adult patients with acquired cholesteatoma were enrolled. The cholesteatoma and matched meatal skin tissues of the patients were immunostained with Ki-67 and p27 antibodies. Canal wall down mastoidectomy was performed in all patients. The differential staining properties––positive staining in the cholesteatoma and negative staining in the skin tissue (C+S-), negative staining in the cholesteatoma and positive staining in the skin tissue(C-S+)––were compared for bone erosion scores (BES), stage, and recurrence rates.Results: Isolated findings in the cholesteatoma tissues, without matching with the skin tissues, demonstrated that stage and recurrence rates were not related to findings in the cholesteatoma tissues (P ˃ .05). However, C+S- for Ki-67 and C-S+ for p27 are risk factors for worse prognosis including advanced stage (P < .001 for Ki-67 and P = .008 for p27), BES values (P < .001 for Ki-67 and P = .001 for p27), and recurrence rates (P < .001 for Ki-67 and P = .037 for p27).Conclusion: This is the first paper assessing the cholesteatoma prognosis according to the differential Ki-67 and p27 staining properties of cholesteatoma and healthy skin tissues. Cellular proliferation rate in the cholesteatoma is important but insufficient by itself for predicting the prognosis of cholesteatoma patients. Patients having lower basal levels of cellular proliferation rate and higher cellular activity in the cholesteatoma tissue are prone to worse prognosis with increased stage, recurrence rates, and degree of bone erosion.

A Novel Instrument for Endoscopic Ear Surgery With a Steerable Flexible Tip: A Pediatric Anatomical Validation Study.

This study compares the reaching ability of two classes of transcanal endoscopic ear surgery (TEES) instruments when operating on difficult to access anatomical targets; two novel instruments with steerable flexible tips (SFT-A and SFT-B) and suction capability are compared with standard commercially available tools. TEES surgeons identified the need for a new surgical instrument that can enable accessibility of all areas visualized by the endoscope. This motivated the development of the two instrument prototypes. Six temporal bone models were 3D printed based on CT data from five cholesteatoma patients. Four anatomical targets were marked on each model. Using these targets, the reaching ability while using four standard TEES instruments were compared with the SFT-A and SFT-B prototypes by five surgeon participants. Results were analysed to compare success rates of contacting each target using each tool by fitting four Firth's logistic regression models. This calculated the statistically significant differences (p < 0.05) in tool success rate. Using SFT-A to contact the sinus tympani (100%) was significantly more successful than the Panetti suction dissector for atticus (PAT) (77%) and to contact the sinodural angle (0%) was less successful than the PAT (10%) and SFT-B (93%). Using SFT-B to contact the lateral semicircular canal (90%) was significantly more successful than all current tools and to contact the sinodural angle (93%) was significantly more successful than all tools. Using SFT-B enables enhanced accessibility of anatomical structures during TEES which may lead to less extensive bone removal to facilitate minimally invasive TEES.

Postoperative pain and analgesic consumption after endoscopic and microscopic ear procedures.

Endoscopic ear surgery (EES) is considered a minimally invasive technique. It is hypothesized that patients after endoscopic procedures experience less pain and require fewer painkillers. Our aim was to compare patients' postoperative pain and need for analgesics in patients undergoing microscopic and endoscopic ear surgeries. a single-institution, prospective study included 92 patients undergoing ear procedures (48 cholesteatoma and 44 reconstructive);(43 endoscopic and 49 microscopic) during 1/2016-1/2018. The postoperative pain (visual analogue scale (VAS) 0-10) and painkillers consumption were recorded and compared in each subgroup. VAS (P=0.02) and analgesics consumption (P=0.06) were lower after endoscopic ear surgeries. In the cholesteatoma group, 94% of endoscopic patients reported VAS 0-2 in contrast to 58 % of microscopic patients on day 1 (P=0.04). Similar tendencies were revealed in reconstructive cases, i.e. 92% compared to 73% (P>0.05). On day 1, 92% of endoscopic, and 77% of microscopic reconstruction patients received no painkillers group (P=0.06). In the cholesteatoma patients, 88% of endoscopic patients, 43% of microscopic patients using endaural approach, and 75% of microscopic patients using retroauricular approach, required no painkillers on the postoperative day 1 (P>0.05). Our study revealed that the EES is associated with less postoperative pain than the conventional microscopic ear surgery. It seems that it is rather the transmeatal approach, and not the endoscope itself that reduces postoperative pain. The removal of the same size cholesteatoma using endoscope (rather than using microscope) leads to less intensive postoperative pain. Consequently, it was not surprising that patients after endoscopic ear surgery very rarely took painkillers.

Comparison of the Hearing Results of Total Ossicular Chain Autogenous Mastoid Cortical Bone Ossiculoplasty and Titanium Total Ossicular Replacement Prosthesis in Patients with Cholesteatoma

Background: No studies have investigated the results of ossicular chain reconstruction using mastoid cortical bone ossiculoplasty (MCBO) and titanium total ossicular replacement prosthesis (TiTORP) in Austin-Kartush Group D cholesteatoma patients with severe middle ear risk index (MERI). Objectives: The present study aimed to compare the hearing results of MCBO and TiTORP in Austin-Kartush Group D cholesteatoma patients with severe MERI who underwent ossicular chain reconstruction during primary surgery. Methods: The hearing results of 28 adult cholesteatoma patients who underwent tympanomastoidectomy and ossicular chain reconstruction with MCBO (n=15) or TiTORP (n=13) were analyzed in the current study. The postoperative hearing was tested 12 months after the surgery. The hearing-related functional success rate was determined in accordance with the American Academy of Otolaryngology-Head and Neck Surgery Foundation criteria. Results: When all patients were taken into account, the mean preoperative and postoperative air-bone gaps (ABG) were reported as 32.2 decibel (dB) and 17.6 dB, respectively, (P&lt;0.001). In 57.1% of the patients, the mean postoperative ABG was ≤ 20 dB. The mean preoperative and postoperative ABGs of the MCBO group were obtained at 29.9 and 16.2 dB, while these values were reported as 35.0 and 19.3 dB in the TiTORP group (P=0.001 and P&lt;0.001, respectively). Hearing-related functional success rates were calculated at 60.0% and 53.8% in MCBO and TiTORP groups, respectively, without any significant difference between the groups (P= 0.743). Conclusion: As evidenced by the obtained results, MCBO and TiTORP can provide similar and successful hearing results in Austin-Kartush Group D patients with cholesteatoma; nonetheless, MCBO is a more cost-effective option in this regard.

Relationship between clinicopathological characteristics and CYLD expression in patients with cholesteatoma.

Middle ear cholesteatoma is a destructive disease in which inflammation plays an important role in development and progression, and there are currently no biomarkers predicting prognosis or recurrence. Cylindromatosis (CYLD), a tumor suppressor deubiquitinase, serves as a negative regulator of inflammation expressed in tissues including the middle ear. To determine the clinical significance of CYLD in acquired cholesteatoma, we evaluated CYLD expression in acquired cholesteatoma tissue by immunostaining and analyzed its correlation with clinicopathological characteristics. Our immunohistochemical analysis revealed that CYLD expression levels were varied in the tissues of acquired cholesteatoma patients. The relative expression levels of CYLD in cholesteatoma exhibited a significant correlation with the grade of otorrhea (R = 0.532, p = 0.039). Moreover, the period of epithelialization was also significantly associated with the relative expression levels of CYLD (R = 0.720, p = 0.002). In addition, CYLD expression tended to be lower in the group with recurrence. These results suggest that low CYLD expression correlates with postoperative recovery of acquired cholesteatoma, while potentially affecting the induction of recurrence. This is the first report showing that low CYLD expression correlates with accelerated disease recovery, and suggests a new aspect of CYLD as a prognostic predictor of acquired cholesteatoma.