Nonmaleficence in the Management of Giant Cholesteatoma: A Case Series

Abstract

Objectives:

(1) Describe the disease process in giant cholesteatomas, a rare, destructive condition with significant morbidity. (2) Review recent experience in the management and outcomes of giant cholesteatoma.

Methods:

Retrospective case series at a tertiary hospital-based academic medical referral center from 2004 to 2011. Three patients with giant temporal bone cholesteatoma who were surgically treated were identified. All 3 patients underwent surgical management with wide exteriorization and routine postoperative debridement. Control of disease was measured through recurrence as seen on follow-up.

Results:

Three adult male patients presented with giant unilateral acquired petrous cholesteatomas over an 8-year period. Two presented with anacusis and facial paralysis, and one with extension of disease to the sphenoid sinus. All were managed with mastoidectomy wide exteriorization; one required an additional staged endoscopic transsphenoidal approach. Hearing and facial function was preserved when present preoperatively. One patient died 5 months postoperatively from H1N1 infection unrelated to his cholesteatoma. Routine postoperative debridement maintained disease control. Follow-up ranged from 5 months to 7 years.

Conclusions:

Exteriorization of giant petrous cholesteatoma combined with routine postoperative debridement is a safe and effective way of preventing long-term complications and disease recurrence.