A study of surgical management of cholesteatoma and its outcome
Author(s): Dr. Mohammed Kareemullah Khan
Background: Cholesteatoma has long been a formidable adversary to the otologic surgeon. There is no single surgical treatment of choice for aural cholesteatoma. Hence it was important to determine the surgical outcomes of cholesteatoma in a country where the prevalence of the disease still remains high.
1.To determine the incidence of residual & recurrent cholesteatoma with various surgical procedures.
2.Evaluation of hearing status at post-operative stage with various surgical procedures.
3.To determine the incidence of post-operative complications such as perichondritis, external auditory canal stenosis, wound dehiscence, facial nerve palsy, and sensorineural hearing loss.
Methods: Prospective study on 50 patients who underwent surgery for cholesteatoma.
Results: Cholesteatoma occurs more commonly in children with otorrhea as the most common presenting symptom. The residual disease rate for ICW mastoidectomy was determined as 12% whereas recurrence rate was nil. CWD mastoidectomy had no residual or recurrent disease in the 6 month follow-up period, but to note is that 5 of the 6 patients who underwent revision surgery for recurrent cholesteatoma had previous CWD mastoidectomy. The net improvement in ABG in ICW mastoidectomy was 16.03(±7.5) dB and that in CWD mastoidectomy was 11.39(±7.4) dB with a significant p value of 0.04 as determined by the independent‘t’ test.
Conclusion: The literature supports the use of both ICW and CWD techniques. Eradication of cholesteatoma has always been the priority, but with advance in the surgical techniques hearing improvement and quality of life issues need to be addressed. With this in the background, ICW mastoidectomy is the preferred choice in our study. However owing to the high incidence of residual disease it is important for the surgeon to counsel the patients regarding the probable need for multiple surgeries. Further studies with long-term follow-up is recommended.