Types Of Cholesteatoma Research Articles

Open-type cholesteatoma is the predictive factor for residual disease in congenital cholesteatoma treated with TEES

ObjectiveTo determine the predictive factors for residual disease occurring after surgical removal of congenital cholesteatomas and whether these predictive factors differ between microscopic ear surgery (MES) using data from the literature and transcanal endoscopic ear surgery (TEES) using data from our own institution. MethodsTwenty-three patients with a congenital cholesteatoma who underwent surgical treatment at Yamagata University Hospital between December 2011 and December 2017 were retrospectively investigated. We divide TEES into three different approaches: non-powered TEES, powered TEES and dual MES/TEES. Main outcome measures were Potsic stage, closed or open congenital cholesteatoma type, TEES surgical approach, appearance of residual disease, tympanoplasty type and hearing outcome. ResultsA logistic regression analysis was conducted on the Potsic stage, closed or open type, TEES surgical approach and age to obtain the odds ratio for residual disease. The chance of residual disease significantly increased in the presence of an open-type congenital cholesteatoma (odds ratio: 30.82; 95 % confidence interval: 1.456–652.3; p = 0.0277), but not for any of the other factors including Potsic stage. The timing of the confirmation of residual disease after ossicular chain reconstruction was analyzed using a Kaplan-Meier analysis. The residual disease rate was significantly higher with an open-type congenital cholesteatoma (log-rank test, p < 0.05). In addition, all residual disease occurred within three years after surgery. ConclusionsOur results showed that an open-type congenital cholesteatoma is the strongest predictive factor for residual disease when removing a congenital cholesteatoma by TEES.

Case Report: Management of Chronic Supurative Otitis Media Cholesteatoma Type with Recurrent Brain Abscess Complication

Introduction: Chronic suppurative otitis media is broadly defined as chronic inflammation that involved mucose of middle ear and mastoid air cells. The most commonly encountered intracranial complication from chronic suppurative otitis media is meningitis followed by brain abscess. Antibiotics are quite effective in early and late cerebritis stage. Surgical intervention is essential once the abscess’s capsule is formed. Case Report: Reported a case of a 22-year-old male diagnosed with chronic suppurative otitis media auris dextra suspected cholesteatoma type with cerebral abscess complications. The managements are cerebral abscess drainage followed by canal wall down mastoidectomy. In patient, Recurrent cerebral abscess formed. Conclusion: Chronic suppurative otitis media with complications of cerebral abscess is treated with abscess drainage if the abscess size is &gt;2cm and followed by canal wall down mastoidectomy. Otogenic brain abscess due to chronic suppurative otitis media can occur repeatedly if abscess antibiotic therapy was/were inadequate&#x0D; Keywords: otogenic brain abscess, mastoidectomy, chronic suppurative otitis media, abscess drainage

Quality of Life Score Difference Based on Chronic Otitis Media Outcome Test-15 (COMOT-15) Questionnaire on Chronic Supurative Otitis Media Patients with and without Cholesteatoma at Sanglah General Hospital

Introduction: Chronic suppurative otitis media (CSOM) is a chronic infection in the middle ear with perforation of the tympanic membrane and persistent or intermittent secretion from the middle ear which is more than two months. It causes a pathological condition in the ear which results in limited hearing function in a person and will affect the quality of life of the patients. Quality of life assessment is carried out to assess the patient's condition and an instrument is needed to be able to evaluate the condition of CSOM patients. Currently, there are several questionnaires that can be used to assess the quality of life of people with CSOM. One of them is the Chronic Otitis Media Outcome Test (COMOT-15) which is a valid measuring tool to subjectively assess the quality of life of people with CSOM. &#x0D; Methods: This study was an observational study with a cross sectional study design. &#x0D; Results: There was a difference in quality-of-life scores between CSOM patients with and without cholesteatoma types with mean score 26.87 (95% CI 22.28- 31.47) (p&lt;0.001).&#x0D; Conclusion: There was a difference in quality-of-life scores between CSOM patients with and without cholesteatoma types at Sanglah General Hospital, Denpasar.

Functional results of surgical treatment of patients with various types of acquired cholesteatoma

To study the long-term functional results of surgical treatment of patients with acquired cholesteatoma, their dependence on the age of patients, the type of cholesteatoma and the type of surgery. The article presents the results of a dynamic comparison of the functional results of surgical treatment of 332 adults and 104 children with various forms of acquired middle ear cholesteatoma who underwent both closed and open surgical procedures. There were no statistically significant differences in hearing function into two age's groups depending on the type of cholesteatoma acquired. Average air conduction in adult patients for all types of cholesteatoma were ranked within 34.55-44.19 dB, air-bone gaps - 24.14-31.12 dB; in children - 33.72-39.16 dB and 27.33-34.95 dB, respectively. The exception was a group of adult patients with secondary cholesteatoma of the pars tensa. In the postoperative period, in patients of both age groups with all types of cholesteatoma, an improvement in the average values of air conduction by 18-20 dB and a decrease in the average values of the air-bone thresholds by 17-21 dB were noted. Analysis of the results of open surgical interventions showed a somewhat worse functional efficiency on 5-9 dB for air conduction average and 18-20 dB for air-bone gaps, both for adults and children. The stability of the achieved level of auditory function at all stages of postoperative observation was also noted. Surgical treatment of children and adult with all types of acquired cholesteatoma can improve hearing function and achieve stable results when using closed or open types of operations.

Nationwide survey of middle ear cholesteatoma surgery cases in Japan: Results from the Japan Otological society registry using the JOS staging and classification system

ObjectiveThis study was aimed to determine the characteristics of middle ear cholesteatoma and to investigate short-term outcomes regarding the rates of residual and recurrent cholesteatoma and the postoperative hearing results in Japan, via a nationwide survey using staging and classification criteria for middle ear cholesteatoma, as proposed by the Japan Otological Society (JOS). MethodsThe first-round survey was conducted in 2016. The target was patients with middle ear cholesteatoma who were surgically treated in Japan between January and December 2015. Medical information on the patients was anonymized. The questionnaire entries were age, sex, cholesteatoma classification and stage, preoperative hearing level, mastoid development, status of the stapes, and surgical method. There were a total of 1,787 registered patients from 74 facilities from all over Japan. The second survey was conducted in January 2018 and received 1,456 responses from 49 facilities in Japan. Of the 1,456 cases, 1,060 were conducted in the postoperative hearing survey and 1,084 in the residual recurrence survey. ResultsThe most common cholesteatoma type was pars flaccida cholesteatoma (63.3%), followed by pars tensa cholesteatoma (13.0%), congenital cholesteatoma (12.9%), and cholesteatoma secondary to chronic tensa perforation (5.6%). Cholesteatoma of uncertain origin accounted for 5.0% (90 cases). Stage II was predominant in pars flaccida and pars tensa cholesteatoma, which frequently involves the mastoid, whereas about half of cases of cholesteatoma secondary to chronic tensa perforation and congenital cholesteatoma were classified as stage I. One hundred fifty-two of 1,084 cases (14.0%) had recurrent cholesteatoma, residual cholesteatoma, or both following first surgeries. The postoperative rates of hearing success rate was 63.3%. ConclusionWe were able to clarify not only the current epidemiological status of middle ear cholesteatoma but also the current trends of cholesteatoma surgery in Japan. The development of a staging system by the JOS Committee serving an epidemiological database for international or time-dependent comparison. It is possible to use this staging system with reasonable reliability.

Uniform Registration Agreements on Cholesteatoma Care: A Nationwide Consensus Procedure.

Background:To coordinate and align the content for registration of cholesteatoma care.Methods:Systematic Delphi consensus procedure, consisting three rounds: two written sessions followed by a face-to-face meeting. Before this procedure, input on important patient outcomes was obtained. Consensus was defined as at least 80% agreement by participants. Hundred-thirty-six adult patients who had undergone cholesteatoma surgery and all ENT surgeons of the Dutch ENT Society were invited. The consensus rounds were attended by ENT surgeons with cholesteatoma surgery experience. Feasibility and acceptability of outcome measures and reporting agreements were assessed in round 1 by 150 ENT surgeons. In round 2 definitions were narrowed and context information to interpret outcome measure were questioned. In round 3, the results, amendments, and the open-ended points were discussed to reach agreement.Results:Most important outcome measures are: 1) the presence or absence of a cholesteatoma in the first 5 years after surgical removal of cholesteatoma, 2) hearing level after surgical removal of cholesteatoma, and 3) the documented assessment of patient's complaints with a validated patient reported outcome measures questionnaire (PROM). Furthermore, consensus was reached on the registration of cholesteatoma type (residual/recurrent), localization of cholesteatoma, and reporting of the presence of cholesteatoma in the follow-up.Conclusion:Consensus was reached on the content and method of registration of cholesteatoma care based on patient's and ENT surgeons input. Three outcome measures were defined. National agreements on the method and content of registration will facilitate monitoring and feedback to the ENT surgeon about the cholesteatoma care.

Влияние патологии протимпанума на результаты хирургического лечения пациентов с приобретенной холестеатомой среднего уха

The article analyzes the state of the protimpanum in various types of acquired cholesteatoma in adults and children. It was found that the spread of cholesteatoma in the protimpanum is observed for all types of acquired cholesteatoma, excluding the sinus cholesteatoma, and pathological changes in the mucous membrane of the protimanum and the bony part of the auditory tube in the form of polyps, granulations – only with primary acquired cholesteatoma. The influence of the pathology of the protimpanum on the choice of the type of surgical intervention and the method of rehabilitation of this middle ear section is noted. According to the study, the frequency of formation of residual cholesteatoma in the group of patients older than 15 years was 14,5%, including 0,9% in the protimpanum, and recurrent – 5,5%. In pediatric patients (from 3 to 15 years), residual cholesteatoma was detected in 18,7% of cases, including 1,9% in the protimpanum, and recurrent in 8,9%. A combination of risk factors such as the condition of the tympanic orifice of the auditory tube (its obstruction and / or anatomical constriction) and closed surgery technique predicted the development of recurrent cholesteatoma in both age groups. Pathological changes in the protimpanum did not affect the incidence of residual cholesteatoma. The key risk factors for the residual process were the type of cholesteatoma and the type of surgical intervention.

The study for the characteristics of secondary acquired cholesteatoma

Objective:Retrospctive analysed the Characteristics and outcomes of surgical treatment of 18 patients who were diagnosed as secondary acquired cholesteatoma (SAC).Method:Patients with SAC accepted operations were enrolled in this study. Then the factors such as sex, age, cource of history, otorrhea before operation, the size of perforation of tympanic membrane, entry site of epithelium, extension direction, ossicular destruction, tympanosclerosis, tympanum tympani tendon involvement, stage of cholesteatoma（JOS, 2015, Japan），degree of gasification of mastoid（JOS，2015，Japan），air conductive threshold, bone conductive threshold, air-bone gap, the healing of tympanic membrane and the auditory improvement were analyzed.Result:Eighteen patients were enrolled in this study, with course of history range from 2 months to 50 years (average: 20.20±16.31) years. There were 14 cases with wet ear before operation. All patients were conformed with perforation of membranal tensa by otoendoscopic photography before operation, with nearly total in 5 ears,large size in 10 ears,medium size in 2 ears and small size in 1 ear. Ossicular erosion were found in 13 patients (malleus involved in 6, incus involved in 12 and stapes involved in 4). Thirteen patients with tendon of tensor tympani involved and 9 patients with tympanosclerosis were conformed during operation. The epithelium entered through the malleus manubrium to the promontory in 13 cases, through the edge of the perforation in 3 cases and through the incus long process to around stapes in 1 case. Cholesteatoma invasion extend to anterosuperior area in 3 cases, posterosuperior area in 3 cases,both in anterosuperior and posterosuperior area in 12 cases. The cholesteatomas classified: stage Ⅰ in 11 cases, stage Ⅱ in 7 cases. Mastoid gasification classified MC0 in 6 cases, MC1 in 10 cases and MC2 in 2 cases. The average air conductive threshold was (56.32±10.15) dB, bone conductive threshold was (20.76±6.22) dB and air-bone gap (35.56±9.84) dB.Tympanic membrane healed in all patients during following up, without recurrent of cholesteatoma, and the post-operative air conductive threshold (43.02±14.96) dB and air-bone gap (21.04±12.90)dB were improved significantly(P<0.05).Conclusion:Most of SAC were secondary to nearly total or large perforation of membranal tensa (83.33%), with relative long history of chronic otitis media (average 20.20 ± 16.31) years and otorrhea before operation. The epithelium entered mainly through the malleus manubrium to the promontory，then through edge of the perforation，by extending anterosuperior and posterosuperior area and usually accompanied with tendon of tensor tympani involved, ossicular destruction, and poor mastoid gasification and tympanosclerosis. The characteristics of SAC were different from other type of cholesteatoma which need further researches.

Risk Factors of Recurrence in Pediatric Congenital Cholesteatoma.

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

Endoscopic transcanal approach to the middle ear for management of pediatric cholesteatoma.

To describe outcomes for endoscopic ear surgery (EES) for pediatric cholesteatoma at a tertiary pediatric hospital. Retrospective case series of 65 pediatric cholesteatoma cases in 38 ears. Subgrouping based on cholesteatoma type and EES type. Surgical findings, outcomes, and demographic data were evaluated. Endoscopes were used in 65 pediatric cholesteatoma cases in 38 primary ears (34 patients), followed for an average of 2.6 years (9 months to 4.6 years). The endoscope was used as the primary visualization tool in 31 (81.6%) ears (EES 2 or 3), and as an adjunct to the microscope in seven ears (EES 1). Twenty-two (57.9%) ears and 35 (53.4%) cases were transcanal endoscopic ear surgery (EES 3 or TEES). Overall, there was recurrence in five (13.2%) ears and residual in four (10.5%) ears. Cholesteatoma was acquired in 27 ears, with average age 10.9 years; and congenital in 11 ears, with average age 3.8 years. Surgical time was longer for acquired cases (226 vs. 154 minutes). Hearing outcomes were comparable for both cholesteatoma types. Residual disease was seen in three (11.1%) acquired ears and one (9.1%) congenital ear. Overall, the lowest rates of recurrent and residual disease were seen in EES 3 cases, and relatively low rates in EES 2 and 3 ears, including four (12.9%) recurrences and two (6.5%) ears with residual disease. The endoscopes are a viable tool for resection of pediatric cholesteatoma and provide excellent visualization of the middle ear and associated recesses. 4. Laryngoscope, 127:2653-2658, 2017.

Clinical features and the results of surgical treatment of the acquired cholesteatoma in the pars tensa of the tympanic membrane

The authors analyzed clinical manifestations and the results of surgical treatment of 204 patients with cholesteatoma in the pars tensa of the tympanic membrane. It has been established that 91.7% of cases are presented by the primary cholesteatoma in the pars tensa, among which 49.0% are the sinus cholesteatoma, and 42.6% are the cholesteatoma of pars tensa of the tympanic membrane proper. 8.3% of the group displays another mechanism of cholesteatoma generation – the secondary mesotympanal cholesteatoma associated with chronic inflammation of the middle ear with the tympanic membrane perforation and tympanosclerosis of various localization and degree. The expansion of cholesteatoma beyond the initial growth point is observed in all types of cholesteatoma. It has been revealed that the maximum degree of ossicular chain destruction is observed in sinus cholesteatoma, here the worst functional result was obtained in the secondary cholesteatoma due to auditory ossicles fixation with tympanoslerosis. The maximum frequency of the both forms of recurrent cholesteatoma – 19.5% – was noted in the cholesteatoma of pars tensa of the tympanic membrane proper, of which 8.0% was due to recurrent disease associated with persistent tubular destruction. Individual choice of surgical approach in each case of middle ear cholesteatoma, long-term postoperative observation using advanced radiological examination methods is the key to the successful treatment of this complex pathology.

Soft-wall reconstruction of the canal wall with retrograde bone work for pediatric cholesteatoma: Long-term results

ObjectiveTo retrospectively evaluate the long-term results of surgery for retrograde bone work, using soft-wall reconstruction of the canal wall, for pediatric cholesteatoma. MethodsWe retrospectively evaluated a series of 25 consecutive ears of 24 patients who were ≤16 years of age. All children underwent cholesteatoma surgery between October 2002 and August 2008. The type of cholesteatoma, the length of follow-up, the incidence of residual and recurrent cholesteatoma, postoperative hearing results, and the form of the reconstructed external canal wall and tympanic membrane were assessed. ResultsThere were 21 males and 3 females. The procedure was performed on both ears of one patient who had bilateral congenital cholesteatoma (CC). At the initial surgery, 16 cases (64%) had CC and nine (36%) had acquired cholesteatoma (AC). The mean age at surgery was 8.2 years and 10.4 years for CC and AC cases, respectively. The mean postoperative follow-up period after the initial surgery was 90 months for CC cases and 108 months for AC cases. Cholesteatoma recurrence occurred for 6% and 56% of cases with CC and AC, respectively. Successful serviceable hearing was achieved for 93.8% with CC and 100% with AC. Cases with inadequate hearing after surgery were characterized by disease extension to the mastoid and the protympanum. The long-term forms of the reconstructed external canal wall changed depending on their middle ear aeration. Some cases of tympanic membrane perforation and otitis media with effusion were occurred during the follow-up period. ConclusionOverall, the retrograde approach with soft-wall reconstruction of the canal wall achieved a low recurrence rate for cholesteatoma and good hearing outcomes during long-term follow-up for the pediatric case. However, in cases with eustachian tube dysfunction and/or cholesteatoma involving the protympanum, the hearing outcomes were less favorable.

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.

Сlinical observations of patients with petrous pyramid cholesteatoma

The article presents the clinical observation of 12 patients with chronic suppurative otitis media complicated with petrous pyramid cholesteatoma. According to the Moffat­Smith 2008 classification, the following types of petrous pyramid cholesteatoma propagation have been revealed: supralabyrinthine (n = 1), supralabyrinthine – apical (n = 2), infralabyrinthine (n = 4), infralabyrinthine – apical (n = ­3), massive (n = ­1) and massive­apical (n = ­1). We analyzed the clinical aspects of each post-surgery patient and surgical approaches of petrous pyramid cholesteatoma excision and the final result of surgical treatment. It has been noted that in infralabyrinthine petrous pyramid cholesteatoma no facial nerve damage which manifests itself in the form of mimic muscles paresis (paralysis) is observed unlike the supralabyrinthine type of cholesteatoma. The incidence of petrous pyramid cholesteatoma is 0.2%.

Hearing loss assessment in primary and secondary acquired cholesteatoma

IntroductionAcquired middle ear cholesteatoma can be classified as primary or secondary. Although both can result in hearing loss, it is still controversial whether there is an association between the type of cholesteatoma and the degree of hearing loss. ObjectiveTo analyze the association between hearing loss and the type of acquired cholesteatoma, and the status of the ossicular chain. MethodsThis was a cross-sectional historical cohort study involving patients diagnosed with acquired cholesteatoma who were surgically treated. Air and bone conduction thresholds, air–bone gaps and the status of the ossicular chain were analyzed for both types of cholesteatoma. ResultsEighty patients aged 5–57 were included in the study. Fifty-one patients had primary cholesteatoma and 29 had secondary cholesteatoma. Both types of cholesteatoma determined greater air–bone gaps at 0.5kHz. Secondary cholesteatoma determined greater hearing loss in all analyzed frequencies and higher air conduction and air–bone gap means. ConclusionThere was association between hearing loss and the type of cholesteatoma. Secondary cholesteatoma resulted in greater hearing impairment.

Etiopathogenesis of acquired cholesteatoma: prominent theories and recent advances in biomolecular research.

To review recent biomolecular advances in etiopathogenesis of acquired cholesteatoma. MEDLINE via OVID (to March 2014) and PubMed (to March 2014). All articles referring to etiopathogenesis of acquired cholesteatoma were identified in the above databases, from which 89 articles were included in this review. The mechanisms underlying the etiopathogenesis of acquired cholesteatoma remain a subject of competing hypotheses. Four theories dominate the debate, including theories of invagination, immigration, squamous metaplasia, and basal cell hyperplasia. However, no single theory has been able to explain the clinical characteristics of all cholesteatoma types: uncoordinated hyperproliferation, invasion, migration, altered differentiation, aggressiveness, and recidivism. Modern technologies have prompted a number of researchers to seek explanations at the molecular level. First, cholesteatomas could be considered an example of uncontrolled cell growth, capable of altering the balance toward cellular hyperproliferation and enhancing the capacity for invasion and osteolysis. Second, the dysregulation of cell growth control involves internal genomic or epigenetic alterations and external stimuli, which induce excessive host immune response to inflammatory and infectious processes. This comprises several complex and dynamic pathophysiologic changes that involve extracellular and intracellular signal transduction cascades. This article summarizes the existing theories and provides conceptual insights into the etiopathogenesis of acquired cholesteatoma, with the aim of stimulating continued efforts to develop a nonsurgical means of treating the disorder.

Clinical analysis of secondary acquired cholesteatoma

ObjectiveThis study aimed to analyze the clinical features of patients who underwent surgery for secondary acquired cholesteatoma (SAC). Materials and methodsThe subjects were 30 patients who underwent surgery for SAC in 30 ears. We investigated the age distribution, sex, tympanic membrane (TM) findings, temporal bone pneumatization, morphology of TM epidermis invasion, extent of cholesteatoma invasion, ossicular erosion, surgical methods and surgical results. ResultsThere were 10 males (33.3%) and 20 females (66.6%), with a mean age 54.9years. The TM perforation was medium-sized or larger in 27 ears (90%). Temporal bone pneumatization was poor or bad in 90% (18/20) of the evaluated ears. The cholesteatoma invaded from the malleus manubrium to the promontory in 23 ears (76.7%). There were no patients in whom the cholesteatoma invaded the antrum or mastoid. The ossicles were affected in 19 ears (63.3%). Ossiculoplasty with a columella on the stapes was the most frequent procedure, performed for 16 ears (53.3%). There were no hearing results with a postoperative air-bone gap of more than 31dB. ConclusionsAlthough SAC is rare, it is important for the clinician to keep this type of cholesteatoma in mind.

Risk Factors of Post-Operative Recidivism in Congenital Cholesteatoma of the Middle Ear

Received May 7, 2014 Revised June 23, 2014 Accepted June 26, 2014 Address for correspondence Hyung-Jong Kim, MD, PhD Department of OtorhinolaryngologyHead and Neck Surgery, Hallym University College of Medicine, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 431-796, Korea Tel +82-31-380-3841 Fax +82-31-386-3860 E-mail hjk1000@hallym.ac.kr Background and ObjectivesZZThere is no general consensus on the risk factors affecting the recurrence or residual disease (recidivism) after surgery of congenital cholesteatoma of the middle ear. In this study, we analyzed clinical characteristics of recidivistic cases after the surgery and compared those of non-recurrent cases to investigate the risk factors regarding the post-operative recidivism of the disease. Subjects and MethodZZData were collected from retrospective chart reviews and computerized database of patients who have underwent surgeries at Kangdong and Hallym University Sacred Heart Hospital during the last 24 years. All surgeries, consisting of 95 primary cases and 24 revision cases, were performed by the same surgeon. ResultsZZRecurrence was detected in 24 cases of the 95 patients (including 4 cases, of which primary surgeries were done at other hospitals). Among the risk factors affecting post-operative recidivism such as sex, age, symptom, disease duration, type of cholesteatoma, mastoid pneumatization, ossicle status, and stage of disease, factors of longer symptom duration, poor mastoid pneumatization, older age, poor mastoid pneumatization, advanced or recurrent cholesteatoma were significantly related to the recidivism of disease. ConclusionZZLonger symptom duration, poor mastoid pneumatization, and advanced or recurrent cholesteatoma were revealed as high risk factors for post-operative recidivism in this study. Korean J Otorhinolaryngol-Head Neck Surg 2014;57(10):664-70

Fallopian canal dehiscence at pediatric cholesteatoma surgery

The objectives of the study were to investigate the characteristics of ears with dehiscence of the fallopian canal at the time of cholesteatoma surgery and the relationship between dehiscence and age, and to consider the reasons why the fallopian canal tends to be preserved in pediatric patients. This study included 37 ears with cholesteatoma in pediatric patients (mean age 9.2 years, age range 4-14 years) and 273 ears with cholesteatoma in non-pediatric patients (mean age 45 years, age range 15-84 years). Patients were treated between January 2006 and April 2012. All patients had undergone prior tympanoplasty under general anesthesia at our institution. Facial canal dehiscence was evaluated by inspection and through palpation by blunt picking after the pathological tissues had been removed. The size of fallopian canal dehiscence was not investigated in this study. The frequency of dehiscence of the fallopian canal according to the type of cholesteatoma and coexisting pathological conditions, including destruction of the stapes, presence of a labyrinthine fistula, and dural exposure, were compared between the pediatric and non-pediatric groups. The frequency of dehiscence in cases with destruction of the stapes was also compared between the pediatric and non-pediatric groups. Dehiscence of the fallopian canal occurred in 6 of 37 ears (16.8 %) in the pediatric group and 91 of 273 ears (33.3 %) in the non-pediatric group (p < 0.05). In congenital cholesteatoma, the frequency of dehiscence was lower in the pediatric group than in the non-pediatric group (p < 0.05). However, in other types of cholesteatoma there was no statistically difference between the two types of cholesteatoma. The frequency of the destruction of the stapes was higher in the pediatric group than in the non-pediatric group (43.2 vs. 16.5 %, p < 0.001). In patients with severe destruction of the stapes, the fallopian canal was preserved more frequently in the pediatric group than in the non-pediatric group (p < 0.05). The frequency of dehiscence of the fallopian canal at the time of cholesteatoma surgery was lower in the ears of pediatric patients than in the ears of non-pediatric patients. This is probably due to the difference in types of cholesteatoma between the two groups and other unknown mechanisms.

Differences in clinical characteristics of fallopian canal dehiscence associated with pars flaccida and pars tensa cholesteatomas

This study investigated the difference in clinical characteristics of fallopian canal dehiscence associated with pars flaccida and pars tensa cholesteatomas for the purpose of increasing the preoperative detectability of dehiscence. A total of 189 ears of patients 7-80 years of age (mean 42 years) with pars flaccida cholesteatoma and 63 ears of patients 9-84 years of age (mean 50 years) with pars tensa cholesteatoma were studied. All patients had undergone prior surgical management at our institution from January 2006 to April 2012. The incidence of fallopian canal dehiscence and its location were compared between pars flaccida and pars tensa cholesteatomas. Intraoperative findings of coexistent pathologies, including destruction of the stapes superstructure, labyrinthine fistula, and dural exposure, were compared between the dehiscence and no-dehiscence groups for the two types of cholesteatomas. The incidence of dehiscence was significantly higher in patients with pars tensa cholesteatoma (55.6 %) than in patients with pars flaccida cholesteatoma (26.5 %). Dehiscence located posterior to the cochleariform process occurred slightly more frequently in patients with pars tensa cholesteatoma than in those with pars flaccida cholesteatoma. In patients with pars flaccida cholesteatoma, labyrinthine fistulas and dural exposure were significantly more frequent in the dehiscence group than in the no-dehiscence group. Fallopian canal dehiscence is more frequent in patients with pars tensa cholesteatoma than in those with pars flaccida cholesteatoma. Especially in patients with pars flaccida cholesteatoma, paying special attention to these coexisting pathologies is important to increase preoperative detectability of dehiscence.