Middle Ear Cholesteatoma and Its Complications

Abstract

Objective: Cholesteatoma is still one of the most challenging ear diseases, its evolution leading sometimes to serious complications (facial palsy, vestibular disorders, meningitis, intracranial abscesses, sigmoid sinus thrombosis, etc). Surgical treatment is always required to heal the disease.

Method: We reviewed the surgical reports of 534 patients treated in the ENT Clinic from Cluj between 2003 to 2010. Patients’ ages ranged from 3 to 81 years, with a mean age of 30 years. The surgical procedure was to follow the cholesteatoma extension from the tympanic cavity to the mastoid cavity.

Results: Most of the cases were operated in closed technique. We have used for ossicular reconstruction incus body without osteitis, the head of the malleus, and cortical of temporal bone. For tympanic membrane and canal wall reconstruction we have used perichondrium cartilage with or without perichondrium. Patients with complications underwent open technique. Recurrence of suppuration was noticed in 28% of cases, requiring a second intervention. Hearing improvement was obtained in 58% of patients, satisfactory results were obtained in 19% of patients, and 23% of patients showed no improvement of hearing.

Conclusion: Autologous materials remain a useful alternative for middle ear reconstruction, improving the hearing in most of the cases. The treatment in cholesteatoma is always surgical, requiring a careful removal of the infection. The surgical technique should be individualized from case to case.