Mastoid Cholesteatoma Research Articles

Therapeutic Misadventure in a Case of Isolated Mastoid Cholesteatoma.

Cholesteatoma is a mass of keratin debris in the middle ear cavity or mastoid. Congenital cholesteatomas may remain asymptomatic for many years and present during adulthood or may even be an incidental finding. We hereby describe a case of 41-year male with an isolated mastoid congenital cholesteatoma with sigmoid plate erosion and posterior cranial dura exposure extending into digastric muscle. Tympanomastoid exploration with sigmoid sinus resurfacing with hydroxyapatite granules was done. However, the case got complicated by extrusion of granules which was then successfully managed. This case report throws light on diagnosis and surgical management of isolated mastoid cholesteatoma. From this misadventure, we learnt that a successful mastoid cavity obliteration (using hydroxyapatite granules) in a canal wall up mastoidectomy can be achieved by providing hermetic seal.

Congenital Mastoid Cholesteatoma with Posterior External Auditory Canal Erosion: A Case Report and Literature Review

Congenital Mastoid Cholesteatoma with Posterior External Auditory Canal Erosion: A Case Report and Literature Review

Outcomes of Soft Versus Bony Canal Wall Reconstruction with Mastoid Obliteration.

To compare recidivism rates, audiometric outcomes, and postoperative complication rates between soft-wall canal wall reconstruction (S-CWR) versus bony-wall CWR (B-CWR) with mastoid obliteration (MO) in patients with cholesteatoma. Retrospective chart review. Tertiary neurotologic referral center. Ninety patients aged ≥18 years old who underwent CWR with MO, either S-CWR or B-CWR, for cholesteatoma with one surgeon from January 2011 to January 2022. Patients were followed postoperatively for at least 12 months with or without second-look ossiculoplasty. Tympanomastoidectomy with CWR (soft vs. bony material) and mastoid obliteration. Recidivism rates; conversion rate to CWD; pre- versus postoperative pure tone averages, speech reception thresholds, word recognition scores, and air-bone gaps; postoperative complication rates. Middle ear and mastoid cholesteatoma recidivism rates were not significantly different between B-CWR (17.3%) and S-CWR (18.4%, p = 0.71). There was no significant difference in pre- versus postoperative change in ABG (B-CWR, -2.1 dB; S-CWR, +1.6 dB; p = 0.91) nor in the proportion of postoperative ABGs <20 dB (B-CWR, 41.3%; S-CWR, 30.7%; p = 0.42) between B-CWR and S-CWR. Further, there were no significant differences in complication rates between B-CWR and S-CWR other than increased minor TM perforations/retractions in B-CWR (63% vs. 40%, p = 0.03). Analysis of recidivism rates, audiometric outcomes and postoperative complications between B-CWR with MO versus S-CWR with MO revealed no significant difference. Both approaches are as effective in eradicating cholesteatoma while preserving relatively normal EAC anatomy and hearing. Surgeon preference and technical skill level may guide the surgeon's choice in approach.

Cholesteatoma Severity Determines the Risk of Recurrent Paediatric Cholesteatoma More Than the Surgical Approach

Objective: To evaluate factors that influence the rate of cholesteatoma recurrence (growth of new retraction cholesteatoma) in children. Methods: Review of children with primary acquired or congenital cholesteatoma. Severity was classified by extent and EAONO-JOS stage, and surgery by SAMEO-ATO. Primary outcome measure was 5-year recurrence rate using Kaplan–Meier or Cox regression analysis. Results: Median age was 10.7 years for 408 cholesteatomas from which 64 recurred. Median follow up was 4.6 years (0–13.5 years) with 5-year recurrence rate of 16% and 10-year of 29%. Congenital cholesteatoma (n = 51) had 15% 5-year recurrence. Of 216 pars tensa cholesteatomas, 5-year recurrence was similar at 14%, whereas recurrence from 100 pars flaccida cholesteatomas was more common at 23% (log-rank, p = 0.001). Sub-division of EAONO-JOS Stage 2 showed more recurrence in those with than without mastoid cholesteatoma (22.1% versus 10%), with more in Stage 3 (31.9%; p = 0.0003). Surgery without mastoidectomy, including totally endoscopic ear surgery, had 11% 5-year recurrence. Canal wall-up tympanomastoidectomy (CWU) and canal wall-down/mastoid obliteration both had 23% 5-year recurrence. Multivariate analysis showed increased recurrence for EAONO-JOS Stage 3 (HR 5.1; CI: 1.4–18.5) at risk syndromes (HR 2.88; 1.1–7.5) and age &lt; 7 years (HR 1.9; 1.1–3.3), but not for surgical category or other factors. Conclusion: Young age and more extensive cholesteatoma increase the risk of recurrent cholesteatoma in children. When controlling for these factors, surgical approach does not have a significant effect on this outcome. Other objectives, such as lower post-operative morbidity and better hearing outcome, may prove to be more appropriate parameters for selecting optimal surgical approach in children.

A Case of Three Ectodermal Origin Congenital Anomalies Including Congenital Mastoid Cholesteatoma

There are several congenital anomalies of the mastoid and external ear. The external ear and mastoid form during the developmental process through the differentiation of ectoderm and mesoderm, and anomalies can arise at various stages. While most congenital anomalies can be easily diagnosed through physical examination, some cases, such as congenital mastoid cholesteatoma, may delay diagnoses. We present a successfully treated case that involved the removal of three simultaneous congenital anomalies of ectodermal origin, which included preauricular fistula, congenital mastoid cholesteatoma, and postauricular epidermal cyst, all found on one ear in a single patient.

Postauricular Cutaneous Mastoid Fistula Surgically Closed by a Temporalis Muscle Rotational Flap: A Case Report

Background: Postauricular cutaneous mastoid fistula (PCMF) is quite rare. Possible triggers include a radical mastoidectomy, chronic suppurative otitis media (CSOM), or the spontaneous exteriorization of a mastoid cholesteatoma through the postauricular skin surface. Case Report: This study reported a 62-year-old woman who presented with a right-sided discharging postauricular lesion for two years and a history of ear discharge over the past 20 years. Physical examination revealed a 10×8 mm fistula with a pearly white tissue at the opening and mucoid discharge. Otoscopy represented an attic cholesteatoma as the potential underlying cause, and computed tomography demonstrated a soft-tissue density in the middle ear extending into the mastoid cavity and towards the cutaneous postauricular area. The PCMF was surgically closed using a temporalis muscle rotational flap with no recurrence at the 6-month follow-up. Conclusion: Overall, surgical closure with a temporalis muscle rotational flap appears to be an effective technique for treating PCMF.

Congenital Mastoid Cholesteatoma of Adult Patient Masquerading as Complicated Otitis Media – A Case Report and Literature Review

The study highlights the management protocol of a large mastoid cholesteatoma presenting with sudden-onset facial palsy mimicking a complicated otitis media and literature review. Congenital cholesteatoma may affect various regions of the temporal bone, the mastoid process being the least frequently involved. The diagnosis is often missed, specifically when the patient presents with features of mastoiditis. Radiology plays an important role in clenching the diagnosis. Congenital (mastoid) cholesteatoma manifesting with features of complicated otitis media is a rare occurrence and needs familiarity to facilitate early diagnosis and appropriate management.

Correlation between functional outcome and the SAMEO-ATO framework.

PurposeTo evaluate the recently proposed SAMEO-ATO framework for middle ear and mastoid surgery, by correlating it with the functional outcome in a large cohort of patients operated for middle ear and mastoid cholesteatoma in a tertiary referral center.MethodsWe retrospectively included all surgeries for middle ear and mastoid cholesteatoma undergone in our Department between January 2009 and December 2014, by excluding revision surgeries, congenital and petrous bone cholesteatoma. All surgeries were classified according to the SAMEO-ATO framework. The post-operative air bone gap (ABG) was calculated and chosen as benchmark parameter for the correlation analysis.Results282 consecutive surgeries for middle ear and mastoid cholesteatoma were released in the study period on a total of 273 patients, with a mean age of 41.2 years. All patients were followed for an average period of 55.3 months. 54% of patients underwent M2c mastoidectomy (Canal Wall Down, CWD), while the remaining underwent Canal Wall Up (CWU) procedures, being M1b2a mastoidectomy the most common one (33%). Mean pre-operative and post-operative ABGs were 29.2 and 23.5 dB, with a significant improvement (p < 0.0001). ‘Mastoidectomy’ and ‘Ossicular reconstruction’ parameters of SAMEO-ATO showed significant association with postoperative ABG, with smaller residual gaps for the classes Mx and On, and worse hearing results for M3a and Ox.ConclusionOur results show the utility of SAMEO-ATO framework, and in particular of ‘M’ (Mastoidectomy) and ‘O’ (Ossicular reconstruction) parameters, in predicting the hearing outcome.

Isolated Congenital Mastoid Cholesteatoma with no Involvement of Aditus Ad Antrum and Middle Ear.

Cholesteatoma is a non-neoplastic, keratinized squamous epithelial lesion that affects the temporal bone. The middle ear is the most frequent, while the isolated cholesteatoma of the mastoid is rare. The aim of this study was to describe a rare case of isolated mastoid cholesteatoma with no involvement of aditus ad antrum and middle ear including a literature review of the topic. This case report describes the case of a 58 years old female with a cholesteatoma isolated in the mastoid region, evidenced by imaging (computer tomography and magnetic resonance). A mastoidectomy was performed: mastoid process was completely involved, but antrum was not reached. Moreover, it reached the soft tissue of stylomastoid foramen as well as the posterior belly of the digastric muscle. In the literature few articles described cases of cholesteatoma isolated in the mastoid region. Research was conducted using PubMed and reference list and there were considered only reports about cholesteatoma exclusively located in the mastoid process without involvement of antrum or middle ear. Fourteen articles were included in this review, with a total number of 23 cases of cholesteatoma isolated in the mastoid region. All papers analyzed reported the cases of isolated mastoid cholesteatoma that presented a congenital origin. Its diagnosis is difficult, therefore, imaging evaluation is mandatory and surgery is the treatment of choice. Mastoid cholesteatomas without involvement of aditus ad antrum and middle ear are rare and only 23 cases are reported in literature. Our case is in line with all clinical and diagnostic features of this rare disease, but it is the only one that evidenced an exposure of the soft tissue of stylomastoid foramen as well as the posterior belly of the digastric muscle. The treatment of choice was the surgical one, avoiding damaging of important anatomo-functional structure.

Comparison between outcome of Inside-out &amp; Outside-in mastoidectomy

Background: Chronic suppurative otitis media is a disease that is known worldwide and that is more common in developing countries. Many techniques are available for operating the disease.&#x0D; Objectives: To compare outcome between Inside-out &amp; Outside-in mastoidectomy.&#x0D; Methods: A cross-sectional study was conducted to compare outcome between Inside-Out &amp; Outside-in mastoidectomy. Period of study was from July’ 2010 to March, 2012 in the Department of Otolaryngology and Head-Neck Surgery, BSMMU- Dhaka&#x0D; Result: majority of the patient were found dry mastoid cavity 13(68.42%) and rest were wet mastoid cavity 6 (31.58%).On the other hand in outside–in mastoidectomy dry mastoid cavity were 80.6% and wet were 19.4%. In inside-out mastoidectomy, among 8 attic cholesteatoma cases 5(62.50%) had gained hearing (average 6.66 dB) and 3(37.50%) had no gain or loss of hearing (average 3.89dB); among 11 entire mastoid bowl cholesteatoma cases 3(27.27%) had gained of hearing (average 6.11dB) and 8(72.73%) had no gain or loss of hearing (average 6.87dB)&#x0D; Bangladesh J Otorhinolaryngol; April 2018; 24(1): 29-36

Preoperative tomography evidence vs surgical findings; A reliable guidance for middle ear surgery?

Our study aimed to determine the accuracy of computed tomography (CT) scan by comparing the preoperative CT findings with the perioperative findings in patients with chronic otitis media (COM). In this study, preoperative CT evidence of 208 patients, who underwent tympanomastoidectomy for COM in Afyonkarahisar Health Sciences University, Otolaryngology Clinic between September 2009 and May 2018, were compared with their surgical findings. When we compared preoperative computed tomography findings with perioperative findings of patients; CT could determine cholesteatoma in mastoid and middle ear space with 74% sensitivity, 64% specificity, 85% positive predictive value (PPV) and 24% negative predictive value (NPV), respectively. Considering ossicular defect, CT could demonstrate the destruction of malleus with 83% sensitivity, 71% specificity, 67% PPV and 66% NPV, destruction of incus with 74% sensitivity, 87% specificity, 92% PPV and 40% NPV, destruction of stapes with 69% sensitivity, 52% specificity, 59% PPV and NPV 51%, respectively. In determining ossicular chain destruction in patients with cholesteatoma, we reached the conclusion that findings of ossicular chain destruction in CT could be judged in favor of cholesteatoma with values of 81% sensitivity, 75% specificity, 93% PPD and 48% NPV. As a result, despite limitations, radiological scanning of the temporal bone with CT is a reliable guide for surgical management of COM with an expert evaluation.

Our first experience with endoscopic ear surgery

For the last decades endoscopic ear surgery has become a common practice. Advantages of the endoscopic technique in middle ear surgery are high definition and magnification of the endoscope with a modern camera and the ability to 'look around the corner' with the angled scope. From March 2017 to November 2019 in NSRC PHOI named after Dmitry Rogachev in the Department of Oncology and Pediatric Surgery 53 patients (81 surgeries) have undergone endoscopic-assisted ear surgery: 3 biopsies for middle ear neoplasm with the transcanal endoscopic approach, 1 endoscopic tympanoplasty for attic retraction pocket with cholesteatoma, 2 endoscopic removal of middle ear tumors (including 1 combined approach) and 32 endoscopic myringoplasties, 22 canal wall down mastoidectomies for extensive middle ear and mastoid cholesteatoma, 21 second-look surgery with ossiculoplasty with overall good outcome. Age of the patients varied from 2 months to 16 years. Follow up period varied from 1 month to 3 years. Two cases of middle ear tumor removal via endoscopic transcanal approach are described. In one case endoscopic transmeatal approach was used as an addition to the middle fossa approach for removal of facial nerve neurinoma located on the upper surface of petrous bone with expansion to the middle ear cavity. In the second case endoscopic transmeatal approach was used alone for removal of benign tumor (salivary gland choristoma) of middle ear cavity with extension to pneumatic system of petrous bone. In both cases endoscopic approach allowed to biopsy the tumor first and then to remove the tumor in a less invasive way, which lead to faster patient recovery. In the majority of cases endoscopic technique is a method of assistance in otologic surgery, but sometimes could be a used a single method in middle ear surgery, allowing less traumatic approach and the implementation of high-definition camera for more precise disease control. In our preliminary experience endoscopic technique could be used in pediatric practice independently of the patient's age.

Dangers of a False Sense of Security in a Huge Mastoid Cholesteatoma With Skull Base Erosion and Cerebrospinal Fluid Leakage

The author reports a case involving a 59-year-old man with delayed presentation of a huge mastoid cholesteatoma complicated by skull base erosion and cerebrospinal fluid leakage. Delayed presentation of this disease entity can have negative health consequences for patients. Regular otologic examinations, audiologic follow-up, and imaging examinations are viewed as the most effective strategies for the prevention of this type of situation. Early recognition of cholesteatomas is essential, as appropriate and timely treatment can prevent this rare comorbid condition from becoming fatal.

Pilot Study Assessing the Feasibility and Clinical Outcomes of Office-Based Ossiculoplasty.

The aim of this study was to assess the feasibility and safety of ossiculoplasty under local anesthesia in an office setting without sedation. Between May 2017 and November 2017, patients who presented with conductive hearing loss and known isolated ossicular discontinuities were offered ossiculoplasty under local anesthesia. Inclusion criteria included age ⩾ 18 years, adequate transcanal access, and the ability to lie supine for up to 45 minutes. Exclusion criteria included associated tympanic membrane perforation and the presence of middleear or mastoid cholesteatoma or infection. Fourteen patients underwent the procedure. The mean age was 48.3 years (range, 19-74 years). Six were primary and 8 revision cases. There were 8 partial and 6 total prosthesis placements. The mean operative time was 34 minutes (range, 26-43 minutes). All patients tolerated the procedure to completion. There were no intraoperative complications. The mean air conduction pure-tone average was 76.6 dB and the mean bone conduction pure-tone average was 27.2 dB, with a preoperative air-bone gap of 49.9 dB. Air conduction pure-tone average significantly improved to 45.2 dB ( P < .0001). Air-bone gap significantly improved to 17.8 dB ( P < .0001). Ossiculoplasty using partial or total prostheses can be safely performed in the office setting under local anesthesia without sedation in carefully selected patients. This has potentially significant patient and system benefits.

Congenital Cholesteatoma in Adults-Interesting Presentations and Management.

To report a series of adult patients diagnosed with congenital cholesteatoma (CC) with respect to symptoms, different varieties of presentation, surgical findings and approach used, complications and the postoperative results. A retrospective chart review of adult cases of CC who were treated in the period from January 2014-2017 was carried out in a tertiary care center. Levenson's criteria were used for diagnosis. Diagnosis was confirmed by imaging and intraoperatively. Postoperative results and complications were also analyzed. Six adult cases of CC were studied with a mean follow up of 10months. Interesting presentations included otitis media with effusion, non-resolving facial nerve palsy, post aural discharge and meningitis. It included 3 cases of petrous apex cholesteatoma, 2 patients with cholesteatoma involving both the middle ear and mastoid and 1 patient with mastoid cholesteatoma. The operative procedures included canal wall up mastoidectomy (1 patient), atticotomy (1 patient), canal wall down mastoidectomy (1 patient), translabyrinthine and transotic excision of mass with blind sac closure (2 patients) and partial labyrinthectomy (1 patient). Complications encountered during surgery were cerebrospinal fluid leak and worsening of hearing in 2 patients and 1 patient respectively. CC can have variety of interesting presentations in adult population and they may or may not have the classical white mass behind the tympanic membrane. Appropriate individualized surgical planning and intervention gives good results.

Huge Mastoid Cholesteatoma with Skull Base Erosion and CSF Leak

Persistent CSF leakage was identified during an extensive mastoidectomy. The complication was rectified by grafting a collagen matrix graft over the leak.

The effects of bone pâté on human osteoblasts cell cultures.

The aim of the present study was to evaluate the effect of bone pate on human osteoblast differentiation by measuring cell viability, alkaline phosphatase activity and expression of the transcription factors and of the major components of the extracellular matrix. Although bone paté has been used in ear surgery for many years and when placed in contact with mastoid and external auditory canal bone become viable, the cellular mechanisms that lead to its osteointegration have never been described. Bone paté taken from four patients subjected to mastoidectomy and affected by middle ear and mastoid cholesteatoma was placed in contact with osteoblast-like cell cultures. Four experimental conditions were obtained: cell cultures treated with bone patè, with bone paté mixed with fibrin glue, with fibrin glue and untreated. After 24h, the viability of the cells was evaluated; after 1week, alkaline phosphatase activity and the expression of transcription factors and bone matrix proteins were assessed by quantitative polymerase chain reaction. After 24h osteoblasts showed increased viability when treated with bone paté (19% increase) and bone pate mixed with fibrin glue (34% increase). After 1week, the number of alkaline phosphatase positive cells increased by 97 and 94% in cultures treated with bone paté alone and bone pate mixed with fibrin glue. Treatment with bone patè upregulated transcription factors and components of the extracellular matrix. The present data show that bone paté has a high osteoinductive potential on human osteoblasts, enhancing their activity.

Quality of Life After Cholesteatoma Surgery

The aim of this study was to evaluate, by means of the Chronic Ear Survey (CES), the quality of life of patients who had undergone either intact-canal wall tympanoplasty (ICWT) or canal wall-down tympanoplasty (CWDT) with mastoid obliteration. This was a retrospective case review study performed at a tertiary referral center. Among 379 patients affected by middle ear and mastoid cholesteatoma operated on between November 2000 and December 2009, 50 patients who underwent ICWT and 50 who underwent CWDT with mastoid obliteration were randomly selected. The CES scores were analyzed for both groups. The mean scores on the CES were 6.5 ± 2.1 in patients who underwent CWDT and 6.9 ± 2.2 in patients treated with ICWT (t = -0.93; p > 0.05). No significant differences between the two groups were found on the activity restriction, symptom, or medical resource subscales (p > 0.05). The results of this study demonstrate that CWDT with mastoid obliteration resulted in a quality of life comparable with that after ICWT. Postoperative hearing loss is the most frequently reported problem for both techniques.

A giant mastoid cholesteatoma with posterior cranial extension causing mass effect and obstructive hydrocephalus

Cholesteatoma is a benign, keratinizing lesion with prolifertion of epithelial cells in the middle ear. Cholesteatomas are ivided into acquired and congenital (primary) subtypes. Acquired holesteatomas usually occur in the middle ear with rare extenion to the petroux apex unlike congenital cholesteatomas. These esions are postulated to be ectopic rests of embryologic epithelial issue in the petrous apex, which failed to undergo involution. As nternal desquamation occurs from the stratified squamous epitheium, keratinized debris accumulates centrally and forms a highly rganized structure. The advancing epithelium combined with host nflammatory response results in surrounding bone resorption [1]. he chronicity of this benign process may cause adjacent bone emodeling and mass effect without early clinical signs. We describe a rare case of giant mastoid cholesteatoma in an dult with consequent deleterious intracranial complications.

Mastoid Cholesteatoma: A Result of Metaplasia

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