Surgery for Chronic otitis media with cholesteatoma: 10-year review
DOI:
https://doi.org/10.34631/sporl.2207Palavras-chave:
Cholesteatoma, Canal wall up, Canal wall down, Tympanoplasty, Tympano-mastoidectomy, Hearing gain, RecidivismResumo
Introduction: Optimal surgical management for Chronic otitis media with cholesteatoma is controversial. Decisions regarding surgical approaches are still highly debated today. Analysing and comparing our experience may help us to expand our common knowledge and predict further outcomes facilitating the discussion and choice of treatment options.Objectives and methodology: The authors conducted a retrospective review of medical records regarding patients who underwent surgery for cholesteatoma from January 2012 to December 2022. Analysis was made regarding preoperative parameters, surgical approaches, hearing results, surgical findings and postoperative complications including relapses.
Results: Ninety-four patients (97 surgical procedures) with chronic otitis media with cholesteatoma were included. Of these, 43 were submitted to a canal-wall-down mastoidectomy, 52 to a canal-wall-up and 2 were managed with an atticotomy. Regarding tympanoplasties, 21.6% underwent a Portmann type 1 procedure, 41.2% a type 2 and 37.1% a type 3. There was an average pure tone average loss of 0.2 dB for wall-up procedures and 1,1 dB for wall-down with an average improvement of 11.8 dB for atticotomies. The overall relapse rate was 21.6% with 9.3% in the wall-down group, 30.8% in the wall-up group and 50% in cases where an atticotomy was performed.
Conclusion: Cholesteatoma surgery requires a highly individualized assessment that considers the extension of the disease, audiometric parameters, surgeon experience and patient receptivity. This study revealed no significant difference in hearing results for both wall-up and wall-down while it favors wall-down surgeries for a safer eradication of the disease.
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Olszewska E, Rutkowska J, Ozgirgin N. Consensus-based recommendations on the definition and classification of cholesteatoma. J Int Adv Otol. 2015 Apr;11(1):81-7. doi: 10.5152/iao.2015.1206.
Watkinson JC, Clarke R. Scott-Brown’s Otorhinolaryngology and Head and Neck Surgery. 8th Ed. Vol 2. Boca Raton: CRC Press; 2018. p. 980-985
Pusalkar AG. Cholesteatoma and Its Management. Indian J Otolaryngol Head Neck Surg. 2015 Sep;67(3):201-4. doi: 10.1007/s12070-015-0891-y.
Alam M, Chandra K. Ears with cholesteatoma: outcomes of canal wall up and down tympano-mastoidectomies—a comparative prospective study. Indian J Otolaryngol Head Neck Surg. 2022 Aug;74(Suppl 1):730-736. doi: 10.1007/s12070-021-02549-1.
Stankovic M. Follow-up of cholesteatoma surgery: open versus closed tympanoplasty. ORL J Otorhinolaryngol Relat Spec. 2007;69(5):299-305. doi: 10.1159/000105482.
Schraff SA, Strasnick B. Pediatric cholesteatoma: a retrospective review. Int J Pediatr Otorhinolaryngol. 2006 Mar;70(3):385-93. doi: 10.1016/j.ijporl.2005.10.006.
Brackmann D, Shelton C, Arriaga MA. Otologic Surgery. 4th ed. Elsevier; 2016.
Yung M, Tono T, Olszewska E, Yamamoto Y, Sudhoff H, Sakagami M. et al. EAONO/JOS joint consensus statements on the definitions, classification and staging of middle ear cholesteatoma. J Int Adv Otol. 2017 Apr;13(1):1-8. doi: 10.5152/iao.2017.3363. 2017.
Portmann Didier, Portmann Michel. Manuel Pratique de Chirurgie Otologique. Bordeaux: Editions Masson; 1997.
Martins O, Victor J, Selesnick S. The relationship between individual ossicular status and conductive hearing loss in cholesteatoma. Otol Neurotol. 2012 Apr;33(3):387-92. doi: 10.1097/MAO.0b013e3182487fb0.
Jeng FC, Tsai MH, Brown CJ. Relationship of preoperative findings and ossicular discontinuity in chronic otitis media. Otol Neurotol. 2003 Jan;24(1):29-32. doi: 10.1097/00129492-200301000-00007.
Carrillo RJ, Yang NW, Abes GT. Probabilities of ossicular discontinuity in chronic suppurative otitis media using pure-tone audiometry. Otol Neurotol. 2007 Dec;28(8):1034-7. doi: 10.1097/MAO.0b013e31815882a6.
Bovi C, Luchena A, Bivona R, Borsetto D, Creber N, Danesi G. Recurrence in cholesteatoma surgery: what have we learnt and where are we going? A narrative review. Acta Otorhinolaryngol Ital. 2023 Apr;43(Suppl 1):S48-S55. doi: 10.14639/0392-100X-suppl.1-43-2023-06.
Muzaffar J, Metcalfe C, Colley S, Coulson C. Diffusion-weighted magnetic resonance imaging for residual and recurrent cholesteatoma: a systematic review and meta-analysis. Clin Otolaryngol. 2017 Jun;42(3):536-543. doi: 10.1111/coa.12762.
Murphy TP, Wallis DL. Hearing results in pediatric patients after canal-wall-up and canal-wall-down mastoid surgery. Otolaryngol Head Neck Surg. 1998 Nov;119(5):439-43. doi: 10.1016/S0194-5998(98)70099-3.
Azevedo AF, Soares AB, Garchet HQ, Sousa NJ. Tympanomastoidectomy: comparison between canal wall-down and canal wall-up techniques in surgery for chronic otitis media. Int Arch Otorhinolaryngol. 2013 Jul;17(3):242-5. doi: 10.7162/S1809-97772013000300002.
Kim MB, Choi J, Lee JK, Park JY, Chu H, Cho YS. et al. Hearing outcomes according to the types of mastoidectomy: a comparison between canal wall up and canal wall down mastoidectomy. Clin Exp Otorhinolaryngol. 2010 Dec;3(4):203-6. doi: 10.3342/ceo.2010.3.4.203.
Şevik Eliçora S, Erdem D, Dinç AE, Damar M, Bişkin S. The effects of surgery type and different ossiculoplasty materials on the hearing results in cholesteatoma surgery. Eur Arch Otorhinolaryngol. 2017 Feb;274(2):773-780. doi: 10.1007/s00405-016-4350-5.
Hirsch BE, Kamerer DB, Doshi S. Single-stage management of cholesteatoma. Otolaryngol Head Neck Surg. 1992 Apr;106(4):351-4. doi: 10.1177/019459989210600406.
Kerckhoffs KG, Kommer MB, van Strien TH, Visscher SJ, Bruijnzeel H, Smit AL. et al. The disease recurrence rate after the canal wall up or canal wall down technique in adults. Laryngoscope. 2016 Apr;126(4):980-7. doi: 10.1002/lary.25591.
Karmarkar S, Bhatia S, Saleh E, DeDonato G, Taibah A, Russo A. et al. Cholesteatoma surgery: the individualized technique. Ann Otol Rhinol Laryngol. 1995 Aug;104(8):591-5. doi: 10.1177/000348949510400801.
Shirazi MA, Muzaffar K, Leonetti JP, Marzo S. Surgical treatment of pediatric cholesteatomas. Laryngoscope. 2006 Sep;116(9):1603-7. doi: 10.1097/01.mlg.0000233248.03276.9b.
Ayache S, Tramier B, Strunski V. Otoendoscopy in cholesteatoma surgery of the middle ear: what benefits can be expected? Otol Neurotol. 2008 Dec;29(8):1085-90. doi: 10.1097/MAO.0b013e318188e8d7.
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Direitos de Autor (c) 2025 Simão Bessa, Noémi Nogueira, Débora Gonçalves, Liliana Costa, Nuno Lousan

Este trabalho encontra-se publicado com a Licença Internacional Creative Commons Atribuição-CompartilhaIgual 4.0.