Epitympanic Cholesteatoma Research Articles

Prognostic Factors of Hearing Improvement for EES and MES in Attic Cholesteatoma.

The surgical strategy of cholesteatomas is still controversial. This study aimed to compare the hearing improvement and determine the prognostic factors between endoscopic and microscopic ear surgery for attic cholesteatoma via a multicenter retrospective study. This retrospective study included 169 patients with attic cholesteatoma who received endoscopic ear surgery (EES) or microscopic ear surgery (MES) from 12 otorhinolaryngology centers. Hearing improvement between EES and MES was evaluated, including the postoperative pure tone average (PTA) and air-bone gap (A-B Gap), as well as the hearing threshold across the low-, mid-, and high-frequency. The success rate of grafts was collected. Linear regression was performed to access the prognostic value of preoperative PTA and A-B Gap. Patients were followed up for at least 3 years. The graft success rate of EES was 89.66% (78/87) versus 80.49% (66/82) for MES. The postoperative PTA and A-B Gap demonstrated significant improvement in EES compared to MES (Post-PTA: t = 3.281, P = .001; Post-A-B Gap: t = 2.197, P = .029). In the EES group, there were 59 ears (67.82%) with a postoperative A-B Gap ≤20 dB HL, which revealed a higher rate of successful hearing outcomes in EES as opposed to MES (χ2 = 9.904, P = .019). There were significantly better hearing improvement, shorter surgical times, and lower hospital stays in EES for epitympanic cholesteatoma without stapes superstructure involvement. The preoperative AC ≤79 dB and/or preoperative A-B Gap ≤52 dB was associated with a better prognosis in EES for epitympanic cholesteatoma with stapes superstructure involvement. EES showed higher graft success rate, better hearing improvement, shorter surgical times and hospital stays for attic cholesteatoma, particularly without stapes superstructure involvement. The range of preoperative PTA and A-B Gap have shown the prognostic value, which maybe a favorable surgical indication for EES or MES.

Endoscopic Cholesteatoma Surgery.

Implementation of endoscopes in cholesteatoma surgery resulted in considerable changes in the management of cholesteatoma in the last two decades. Compared to the microscopic approach with an excellent but straight-line view and limited illumination, the introduction of endoscopes provides a wide-angled panoramic view. Moreover, angled lenses allow the surgeon to visualize the middle ear and its hidden recesses through a transcanal, minimally-invasive approach. The endoscope enables the surgeon to remove limited cholesteatoma of the middle ear and its recesses using an exclusive endoscopic technique by taking advantage of these benefits. This reduces the rate of residual disease and sparing external incisions and excessive temporal bone drilling as in a transmastoid approach. Since transcanal endoscopic access is mainly a one-handed technique, it implies the need for specific procedures and technical refinements. This article describes a step-by-step guide as a surgical manual for endoscopic removal of epitympanic cholesteatoma. Different techniques for cholesteatoma dissection and bone removal for epitympanectomy, including curettage and powered instruments such as drills and ultrasonic devices with their outcomes, are discussed. This may offer ear surgeons insight into technical refinements and the latest technological developments and open the horizon for different techniques.

Transcanal Endoscopic Ear Surgery for Epitympanic Cholesteatoma With Obliteration Using Bioglass.

Transcanal Endoscopic Ear Surgery for Epitympanic Cholesteatoma With Obliteration Using Bioglass.

Application of a novel transcanal keyhole technique in endoscopic cholesteatoma surgery

Background It is difficult to deal with epitympanic cholesteatoma in otologic surgery. The keyhole technique can realize minimally invasive surgery and reconstruct the middle ear canal. Objective To explore the clinical application of keyhole technique in primary and second-look surgery in middle ear cholesteatoma. Materials and Methods 34 cases were analyzed retrospectively in terms of residual and recurrence rate, safety (adverse events) and hearing performance at long-term follow-up. The application of the technique in primary or second stage operation was evaluated and the operation was performed by transanal endoscopy or combined approach. Results The cholesteatoma revealed by CT before operation was limited to the attic in 23 patients, of which 16 had the same imaging range as that of the keyhole technique. The preoperative imaging findings of 11 showed that the attic cholesteatoma may have extended into the mastoid, of which only 6 cases were confirmed by keyhole technique. An endoscopic second-look surgery using the keyhole technique was performed for these patients, 2 were confirmed to have residual lesions in the attic. Conclusions The keyhole technique under otoendoscopy can be used flexibly and conveniently in the second-look surgery to make up for the shortage of diffusion-weighted magnetic resonance imaging.

Wideband Absorbance in Ears with Retraction Pockets and Cholesteatomas: A Preliminary Study.

The objective of this study was to describe wideband absorbance (WBA) findings in patients with cholesteatomas and retraction pockets (RPs). In this prospective study, tympanometry, audiometry, and wideband tympanometry (WBT) were performed on 27 ears with an RP (eight with epitympanic RP and 19 ears with mesotympanic RP), 39 ears with a cholesteatoma (23 ears with epitympanic and 16 ears with mesotympanic cholesteatomas [MCs]), and 49 healthy ears serving as controls. Mean WBA at ambient pressure (WBAamb) of both experimental groups was reduced significantly between 0.8 and 5 kHz relative to the control group. The difference between mean WBAamb and mean WBA at tympanometric peak pressure (WBATPP) was greater for the RP (0.12-0.16 between 0.5 and 1.5 kHz) than for the cholesteatoma group (0.03-0.11 between 0.6 and 3 kHz). Mean WBAamb of both epitympanic RP (ERP) and epitympanic cholesteatoma (EC) subgroups was significantly lower than that of the control group. Mean WBATPP of the ERP subgroup attained normal levels as per the control group, while mean WBATPP of EC subgroup was significantly lower than that of the control group at 0.8 to 1.5 kHz and 4 to 5 kHz. In contrast, both mesotympanic RP and MC subgroups demonstrated similar mean WBAamb and WBATPP values. No significant differences in WBAamb and WBATPP results between the RP and cholesteatomas groups were observed. Receiver operating characteristic (ROC) analyses indicated that the area under the ROC curve for distinguishing between the RP and cholesteatomas groups ranged from 0.44 to 0.60, indicating low accuracy in separating the two groups. While it is not possible to distinguish between the RP and cholesteatomas groups based on the WBAamb and WBATPP results, it is potentially feasible to differentiate between the EC and ERP conditions. Further study using a large clinical sample is recommended to determine the sensitivity and specificity of the WBA test to identify the EC and ERP conditions.

Transcanal endoscopic management of epitympanic cholesteatoma: a promising technique

<p class="abstract"><strong>Background:</strong> The objective of the study was to evaluate the role of functional endoscopic ear surgery in epitympanic cholesteatoma removal.</p><p class="abstract"><strong>Methods:</strong> This study included 15 cases of epitympanic cholesteatoma who underwent exclusive endoscopic surgeries for cholesteatoma removal in a tertiary care centre between December 2017 to May 2018. The improvement in hearing threshold and air bone closure was evaluated comparing the preoperative and postoperative audiogram. The incidence of recurrence and reperforation was noted postoperatively using otoendoscopy. </p><p class="abstract"><strong>Results:</strong> Post-surgery improvement in hearing threshold was observed. There was no incidence of recurrence and reperforation during the mean follow up period of 7.8 months.</p><p class="abstract"><strong>Conclusions:</strong> Endoscopic removal of epitympanic cholesteatoma is more natural way of removal of disease with less post-surgery morbidity and recurrence. It has potential to be a promising tool for treatment of epitympanic cholesteatoma in future.</p><p class="abstract"> </p>

Improvement of otoendoscopic surgery for epitympanic cholesteatoma invading the mastoid

Background: In recent years, the otoendoscopic surgery for epitympanic cholesteatoma has achieved great development, but it still has some disadvantages.Objective: This work aims to improve otoendoscopic surgery for epitympanic cholesteatoma invading the mastoid to retain the normal structure of the middle ear as much as possible.Methods: We classified the patients according to the lesion scope and applied different strategies of using the combination of otoendoscope and microscope. The surgery was improved and the recurrence and residual of middle ear cholesteatoma after operation were observed preliminarily.Results: Forty-six patients with middle ear cholesteatoma accepted surgical treatment, including 10 cases of independent otoendoscopic surgery, 29 cases of otoendoscope–microscope combined surgery, and seven cases of microscopic surgery assisted with an otoendoscope. All cases were treated with canal-up cholesteatoma surgery. The postoperative recurrent rate was 4/46.Conclusion: We improved existing otoendoscopic surgery to reduce or avoid bony defects of the acoustic meatus, and then decreased the proportion of canal-down surgery.

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.

Cholesteatoma growth patterns: are there audiometric differences between posterior epitympanic and posterior mesotympanic cholesteatoma?

The objective of this is to verify whether the hearing impairment caused by posterior epitympanic differed from that caused by posterior mesotympanic cholesteatomas by a cross-sectional study. We evaluated 264 ears of patients with cholesteatoma, who had not been subjected to ear surgery. Otoendoscopy and pure-tone audiometry were performed. Analyzed route involved in cholesteatoma formation: posterior epitympanic or posterior mesotympanic, air-bone gaps at 512-4000Hz and pure-tone averages. The mean age of the patients enrolled in this study was 33.8years, and 51.8% of them was male. Posterior epitympanic cholesteatoma was found in 50.4% of the study population. When the air-bone gaps were compared, the mesotympanic group had greater thresholds at 500, 2000 Hz, and a greater pure-tone average (P=0.003, P=0.03, and P=0.02, respectively). Posterior mesotympanic cholesteatoma showed greater air-bone gaps thresholds at the speech frequencies than posterior epitympanic cholesteatoma did. Moreover, the two growth patterns were very similar with regard to all other audiometric parameters analyzed in this study.

Classification of Cholesteatoma According to Growth Patterns.

Several classifications of cholesteatoma exist, but there are controversies about their clinical application. To classify cholesteatomas and describe the prevalence of the subtypes. A cross-sectional comparative study of 414 ears in 356 consecutive patients with middle ear cholesteatoma and no history of ear surgery treated at a tertiary hospital was conducted from March 8, 2000, to March 30, 2015. Data analysis was conducted from March 30, 2014, to March 30, 2015. Otoendoscopy was conducted, and findings for both ears were recorded. Cholesteatoma growth patterns were classified as anterior epitympanic, posterior epitympanic, posterior mesotympanic, 2 routes (both the pars flaccida and the pars tensa are involved), and undetermined. Among the 356 patients in this study, mean (SD) patient age was 33.23 (19.81) years (range, 4-82 years), and 125 patients (35.1%) were female. The right ear was identified as the affected ear in 220 patients (61.8%). A total of 272 (65.7%) ears were from adults. Of the 414 ears that underwent otoendoscopy, posterior epitympanic (142 [34.3%]) and posterior mesotympanic (140 [33.8%]) were the most frequent types of cholesteatoma observed, followed by undetermined (67 [16.2%]) and 2 routes (57 [13.8%]). Anterior epitympanic type was the least frequent (8 [1.9%]). Posterior epitympanic cholesteatoma was more prevalent in adults (111 [40.8%]), whereas posterior mesotympanic cholesteatoma was more frequent in children (43.0%) (P < .001). Anterior epitympanic cholesteatoma was observed only in children. Classifying cholesteatomas according to the growth pattern (anterior epitympanic, posterior epitympanic, posterior mesotympanic, 2 routes, and undetermined) includes all existing types of cholesteatomas of the middle ear. In general, the prevalence of posterior epitympanic and posterior mesotympanic cholesteatoma were similar. Whereas anterior epitympanic and posterior mesotympanic cholesteatomas were more prevalent in children, posterior epitympanic cholesteatoma was more frequent in adults.

Is endoscopic ear surgery an alternative to the modified Bondy technique for limited epitympanic cholesteatoma?

The objective of this study is to evaluate the outcomes of the modified Bondy's technique performed at our center and for limited epitympanic cholesteatomas and to debate the purported benefits of endoscopic surgery for the same indication. This is a retrospective study. 269 ears of 258 patients with a minimum of 5-year follow-up that were operated for limited epitympanic cholesteatoma using the modified Bondy's technique were included in the study. All patients had primary acquired cholesteatoma with good preoperative hearing in the affected ear and an intact ossicular chain. The outcomes of were analyzed and the results were compared with a literature review of outcomes of endoscopic ear surgery for the same indication. The mean follow-up was 81.63months. The mean preoperative air-bone gap was 13.6±7dB. Intraoperatively, the ossicular chain was preserved in all patients. Postoperatively, there was no significant change from preoperative levels in mean air conduction, mean bone conduction and the air-bone gap. There were no recurrent cholesteatomas in our series. A residual pearl-like cholesteatoma was found lateral to the tympanic membrane in 8.1% of ears, which was removed in the outpatient clinic. Three patients (1.2%) developed stenosis of the meatoplasty. Eight (3.1%) ears exhibited retraction pockets involving the attic. Postoperative ear discharge was observed in 1.5% cases. The modified Bondy technique, which provides excellent postoperative outcomes, is the surgery of choice for limited epitympanic cholesteatomas. The endoscope, despite its better visualization of hidden areas does not provide a distinct overall technical advantage or better results over the microscope.

Cholesteatoma in Children: An Overview

Objectives: Describe in children: (1) cholesteatoma growth patterns; (2) conductive hearing loss severity; (3) contralateral ear (CLE) findings. Methods: Cross-sectional study. Videotoscopies of 129 pediatric patients at a tertiary care hospital were analyzed for cholesteatoma growth patterns, air-bone gap, and CLE otoscopic findings. Data were compared with the chi-squared test and analyzed using SPSS. Results: The mean patient age was 12.4 ± 4.36 years. The cholesteatoma growth patterns were anterior epitympanic cholesteatomas (5.4%), posterior epitympanic (21.7%), posterior mesotympanic (43.4%), 2 routes pattern (17.1%), and undetermined (12.4%). The pure tone average air-bone gap (PTA-ABG) was ≤20 dB in 8.7% of patients, between 20 to 40 dB in 43.4% of patients, and ≥40 dB in 47.9%. The CLE was normal in 34.9% of patients and had moderate or severe tympanic membrane (TM) retractions in 46.5%, TM perforation in 7.8%, and cholesteatoma in 10.9% of patients. The CLE disease prevalence was similar between the groups, except in anterior epitympanic group, which had normal CLE ( P = .004). Conclusions: Posterior mesotympanic cholesteatomas were the most prevalent in the study population. Most patients had a PTA-ABG greater than 20 dB, and the most prevalent CLE abnormalities were moderate or severe TM retraction and cholesteatoma. The CLE of patients diagnosed with anterior epitympanic cholesteatoma were normal, suggesting a probable congenital origin.

Acquired middle ear cholesteatoma in children with cleft palate: Experience from 18 surgical cases

ObjectivesTo review an institutional experience with the surgical management of middle ear cholesteatoma in children with cleft palate. Materials and methodsWe analyzed retrospectively 18 children diagnosed with cleft palate who underwent surgery for acquired middle ear cholesteatoma between 2000 and 2007. The following data were recorded: age, sex, history of ventilation tube insertion, status of the contralateral ear, cholesteatoma location and extension, and surgical technique involved. Cholesteatoma recidivism, stable mastoid cavity and hearing levels were the main outcomes measured. ResultsFollow-up ranged from 5 to 12 years (mean 8 years). Twelve children underwent planned staged canal wall up mastoidectomy: a residual cholesteatoma was found and removed during the second-look procedure in 2 ears (16.6%); two children (16.6%) showed a recurrent cholesteatoma and required conversion to canal wall down mastoidectomy. A modified Bondy technique was chosen in two children with an epitympanic cholesteatoma with an intact tympano-ossicular system, while in the remaining four subjects a canal wall down mastoidectomy was performed because of an irreparable erosion of the postero-superior canal wall: no cases of recurrent cholesteatoma were observed in these 6 children; revision mastoidectomy was needed in one patient for cavity granulation. A postoperative air-bone gap result of 0–20dB was achieved in 11 children (61.1%); in 5 cases (27.7%) postoperative air-bone gap was between 21 and 30dB, while in 2 (11.1%) was >30dB. Bone conduction thresholds remained unaffected in all cases. ConclusionsOur results indicate that most cleft palate children with cholesteatoma can be managed with a canal wall up mastoidectomy with low complication rates. In extensive disease with large erosion of the canal wall as well in presence of a retraction pocket in the contralateral ear, a canal wall down mastoidectomy should be considered. In epitympanic cholesteatomas with an intact tympano-ossicular system and mesotympanum free of disease, the modified Bondy procedure is an effective surgical option. As in the general pediatric population, improvement or preservation of hearing can be obtained in most patients.

Cholesteatoma Growth Patterns: Are There Audiometric Differences between Posterior Epitympanics and Mesotympanics?

Objectives: Verify if there are differences in hearing impairment between posterior epitympanic and posterior mesotympanic cholesteatomas. Methods: This cross-sectional study evaluated 278 ears with cholesteatoma and no previous surgery between August 2000 and January 2013. Otoendoscopy and pure tone audiometry were performed at the first evaluation. The video-otoscopys were later analyzed and classified between the two main possible routes involved in cholesteatoma formation (posterior epitympanic and posterior mesotympanic). To compare the audiometric thresholds, we employed the Student t test. Results: The mean age was 33.7 years old, and 51.1% were male. The posterior epitympanic cholesteatoma was found in 51.4%. There were no differences in air and bone conduction thresholds between the two groups ( P &gt; 0.05). When the air-bone gaps were compared, however, the posterior mesotympanics had greater thresholds in 500 Hz, 2000Hz, and tritonal mean ( P = 0.003, P = 0.03, and P = 0.02, respectively) Conclusions: The posterior mesotympanic cholesteatomas had greater air-bone gap thresholds in the speech frequencies when compared with posterior epitympanic cholesteatomas. However, the two growth patterns were very similar in the other audiometric parameters.

OSSICULAR CHAIN PRESERVATION IN EPITYMPANIC CHOLESTEATOMA SURGERY

To the Editor: We read the recent article by Marchioni et al. (1) about ossicular chain preservation using the endoscopic transcanal tympanoplasty approach with great interest. We agree with the authors that when it does not compromise cholesteatoma removal, the entire ossicular chain should be preserved to achieve optimum hearing results. Even the best prosthetic ossicular reconstruction cannot consistently match the hearing possible with an intact, mobile ossicular chain. However, the endoscopic technique for addressing epitympanic cholesteatoma only allows for ossicular chain preservation in 56.5% of cases and was much less successful when the cholesteatoma involved multiple subsites, especially the medial attic and antrum. Additionally, the reported recurrence rate in the middle ear is 13%. We believe the modified Bondy technique is the procedure of choice in cases of uncomplicated, epitympanic cholesteatoma with an intact ossicular chain and pars tensa (2). In our series of 230 consecutive cases (3), we were able to preserve an intact ossicular chain in all cases and were able to eradicate disease in 1 stage, regardless of location in the epitympanum. There was no recurrent disease in the middle ear after a follow-up period exceeding 7 years. Postoperatively, 88% of our patients had preserved or improved hearing by air conduction. This technique allows for bimanual surgery and is not limited by external canal size or bleeding, which makes an endoscopic approach difficult. Of course, cholesteatoma surgery is complex, and no one surgical approach can be applied to all circumstances. No single surgical technique can substitute for sound surgical decision making and mastery of a variety of surgical approaches. We commend the authors for their work in exploring novel ways of addressing a challenging problem. Mario Sanna, M.D. Trac M. Duong, M.D. Gruppo Otologico Piacenza, Italy

Cholesteatoma Localization in the Contralateral Ear

Objective: Acquired cholesteatoma has been extensively studied. Theories that involve previous tympanic membrane retractions in the cholesteatoma pathogenesis are the most accepted. However we do not know what happens in the contralateral ear. We want to evaluate and compare the localization of acquired cholesteatomas in patients with bilateral disease. Method: This is a transversal study. We evaluated 1,015 patients with chronic otitis media in at least one ear and no previous surgery between August 2000 and January 2011. Otoendoscopy was carried out and recorded on the affected ear just as in the contralateral, which was classified. Results: Two hundred and sixty patients with chronic otitis media with cholesteatoma were included. The mean age was 31.7 years, and 52.7% were male. Cholesteatoma was found in 17% of the contralateral ears. In the case of an epitympanic cholesteatoma in one ear, the cholesteatoma in the other ear was in the same site in 92% of patients. On the other hand, if it was mesotympanic posterior in one ear, the cholesteatoma in the contralateral ear was in the same location in 80%. Conclusion: The results suggest that patients with acquired cholesteatoma have a greater probability of having a cholesteatoma in the same site in the contralateral ear. This corroborates the idea that chronic otitis media with cholesteatoma is not only an isolated event but a constitutional process with a high prevalence of bilaterality.

The contribution of selective dysventilation to attical middle ear pathology

Epitympanic primary cholesteatoma represents a challenge for ENT surgeons. Its exact pathogenesis is still unknown because of the very complex anatomy of this region. Until now, only a few authors have described this region and tried to hypothesize the causes that could lead to cholesteatoma genesis. We hypothesize the existence of a selective dysventilation of the epitympanic region based on the presence of various mucosal folds occluding air ventilation from the middle ear to the epitympanum, through the epitympanic isthmus, causing a negative epitympanic pressure and consequently cholesteatoma formation. All the anatomic findings were obtained with the aid of 0° and 45° angled surgical endoscopes. From our findings, patients affected by an epitympanic cholesteatoma often have a total isthmus blockage that completely isolates the whole epitympanum from the middle ear, causing a deficit of oxygenation of the mucosa that normally should be guaranteed by the Eustachian tube and which always works physiologically in these patients. This is confirmed by the tympanogram test where we observed how the pressure at the level of the tympanic cavity was normal, whereas the epitympanic pressure was selectively negative. In conclusion, selective epitympanic dysventilation syndrome consists of the concomitant presence of a series of complete or incomplete epitympanic diaphragms and ME isthmus blockage causing negative epitympanic pressure, and leading to the formation of a retraction pocket or cholesteatoma associated with normal Eustachian tube function.

Modified Bondy's Technique

To evaluate the short- (6 mo) and long-term (5 yr) outcomes of modified Bondy technique, with particular reference to hearing results. Retrospective study. Quaternary referral otology and cranial base center. Two hundred thirty ears of 222 patients were operated on, using a modified Bondy technique between 1983 and 2005. All patients had primary acquired epitympanic cholesteatomas with intact pars tensa and intact ossicular chain in normal or good-hearing ear. Preoperative audiometric results revealed a mean air conduction pure-tone average of 27.7 +/- 9.6 dB (range, 10-65 dB) and a mean bone conduction pure-tone average of 14.2 +/- 6.4 dB (range, 5-50 dB). The mean preoperative air-bone gap was 13.5 +/- 6.7 dB (range, 0-25 dB). The average length of follow-up was 7.8 years (range, 5-16 yr). There was no recurrent cholesteatoma in the present series. A pearl-like residual cholesteatoma was found in the cavity in 7.4% of ears. Two patients (0.8%) developed stenosis of meatoplasty. Three ears (1.3%) exhibited retraction pockets extending to the attic. Postoperative discharging ear was observed in 3% of cases and was successfully treated with topical drops. At the long-term follow-up, the air-bone gap was unchanged or improved from the preoperative level in 88% of cases. The mean postoperative short- and long-term air-bone gaps were 14.6 +/- 8.5 dB (range, 0-55 dB) and 14.1 +/- 8.2 dB (range, 0-50 dB), respectively. Postoperative high-frequency sensorineural hearing loss with bone conduction worsening between 20 and 30 dB at 4 kHz was observed in 4 cases (1.7%). No dead ears were encountered postoperatively. A modified Bondy operation is recommended in selected cases of epitympanic cholesteatoma in normal or good-hearing ear with an intact pars tensa and ossicular chain. Modified Bondy technique ensures complete eradication of disease while preserving a good preoperative hearing in 1-stage operation.

Modified Bondy's technique for epitympanic cholesteatoma.

The LaryngoscopeVolume 113, Issue 12 p. 2218-2221 Article Modified Bondy's Technique for Epitympanic Cholesteatoma† Mario Sanna MD, Corresponding Author Mario Sanna MD [email protected] Gruppo Otologico, Piacenza, Italy.Dr. Mario Sanna, Gruppo Otologico, Via Emmanueli 42, 29100 Piacenza, Italy.Search for more papers by this authorManoj Agarwal DLO RCS, DLO(Cal), Manoj Agarwal DLO RCS, DLO(Cal) Gruppo Otologico, Piacenza, Italy.Search for more papers by this authorTarek Khrais FRCS(I), HSDM, Tarek Khrais FRCS(I), HSDM Gruppo Otologico, Piacenza, Italy.Search for more papers by this authorGiuseppe Di Trapani MD, Giuseppe Di Trapani MD Gruppo Otologico, Piacenza, Italy.Search for more papers by this author Mario Sanna MD, Corresponding Author Mario Sanna MD [email protected] Gruppo Otologico, Piacenza, Italy.Dr. Mario Sanna, Gruppo Otologico, Via Emmanueli 42, 29100 Piacenza, Italy.Search for more papers by this authorManoj Agarwal DLO RCS, DLO(Cal), Manoj Agarwal DLO RCS, DLO(Cal) Gruppo Otologico, Piacenza, Italy.Search for more papers by this authorTarek Khrais FRCS(I), HSDM, Tarek Khrais FRCS(I), HSDM Gruppo Otologico, Piacenza, Italy.Search for more papers by this authorGiuseppe Di Trapani MD, Giuseppe Di Trapani MD Gruppo Otologico, Piacenza, Italy.Search for more papers by this author First published: 03 January 2009 https://doi.org/10.1097/00005537-200312000-00032Citations: 8 † This article supported by a grant from Associazione Studio Aggiornamento Basicranio. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume113, Issue12December 2003Pages 2218-2221 RelatedInformation

Selective indications for the management of extensive anterior epitympanic cholesteatoma via combined transmastoid/middle fossa approach.

Cholesteatoma that is present in the anterior epitympanic space may extend medially along the supralabyrinthine route to the geniculate ganglion, labyrinth, and cochlea and medially toward Kawase's triangle and the anterior petrous apex. Superiorly it may erode into the middle fossa. Contemporary microsurgical techniques allow for optimal management of these lesions with minimal morbidity, provided that the irregular and complex osteology of the petrous base is understood. The objective of the study was to review the relevant regional anatomy, pathobiology, and current algorithm used in treatment of this select patient population using a combined transmastoid/middle fossa (TM/MF) approach. A retrospective review was performed of all clinical and radiographic data from patients undergoing combined TM/MF management of extensive anterior epitympanic cholesteatoma between July 1984 and June 1998. Data from physical examinations, preoperative imaging studies, and operative findings and other relevant data were tabulated and analyzed for patients undergoing TM/MF management of cholesteatoma. Of 488 patients with cholesteatoma treated by the otological service between 1984 and 1998, 11 patients underwent TM/MF exposure and removal of anterior epitympanic cholesteatoma. Total cholesteatoma removal was accomplished in six patients. In three patients, because of facial nerve involvement, labyrinthine fistulae, or internal carotid artery involvement, open-cavity surgery was performed. In two patients, residual or recurrent cholesteatoma was exteriorized at "second-look" procedures. In this small cohort of patients the majority had extension to the arcuate eminence, geniculate ganglion, or Kawase's triangle or had "blue-lining" of the cochlea or labyrinth. To a lesser degree, the middle ear and mastoid contents were involved. Further facial nerve dysfunction or sensorineural hearing loss was not noted after surgery. Selective TM/MF removal of cholesteatoma provides an optimal route for removing complex cholesteatoma in patients with intact sensorineural function and medial cholesteatoma extension.