Skip to main content

Effect of surgical intervention on middle-ear cholesteatoma with associated facial paralysis

  • Y Ozkul (a1), M Songu (a1), K Onal (a1), A Imre (a1), S Arslanoglu (a1), E Horoz (a1), F Bayrak (a1) and E Pinar (a1)...

To investigate the presenting symptoms, intra-operative findings and long-term facial nerve function in patients treated for cholesteatoma with associated facial paralysis.


Fifteen patients with facial paralysis due to middle-ear cholesteatoma who underwent tympanomastoidectomy surgery from February 2000 to February 2015 were retrospectively reviewed. After removal of the cholesteatoma, a limited area of the fallopian canal, in which facial nerve oedema or redness was evident, was opened. Incision of the epineural sheath for nerve decompression was not performed.


Pre-operative House–Brackmann grade was grade II in two patients, grade III in four, grade IV in seven, grade V in one and grade VI in one. Facial nerve perineurium damage was observed in two patients with poor prognoses. All patients treated within the first 15 days after paralysis onset showed normal facial function at long-term follow up. Post-operative House–Brackmann grade was grade I in 11 patients, grade II in 1, grade III in 2 and grade VI in 1.


Early surgical treatment is more likely to give good results, and poor outcomes are observed in patients with facial nerve perineurium damage.

Corresponding author
Address for correspondence: Assoc Prof Murat Songu, Department of Otorhinolaryngology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Turkey Fax: +90 232 243 1530 E-mail:
Hide All
1 Choi, JW, Park, YH. Facial nerve paralysis in patients with chronic ear ınfections: surgical outcomes and radiologic analysis. Clin Exp Otorhinolaryngol 2015;8:218–23
2 Prasad, SC, Shin, SH, Russo, A, Di, Trapani G, Sanna, M. Current trends in the management of the complications of chronic otitis media with cholesteatoma. Curr Opin Otolaryngol Head Neck Surg 2013;21:446–54
3 Ozbek, C, Somuk, T, Ciftçi, O, Ozdem, C. Management of facial nerve paralysis in noncholesteatomatous chronic otitis media. B-ENT 2009;5:73–7
4 Sharma, N, Jaiswal, AA, Banerjee, PK, Garg, AK. Complications of chronic suppurative otitis media and their management: a single ınstitution 12 years experience. Indian J Otolaryngol Head Neck Surg 2015;67:353–60
5 Sengupta, A, Anwar, T, Ghosh, D, Basak, B. A study of surgical management of chronic suppurative otitis media with cholesteatoma and its outcome. Indian J Otolaryngol Head Neck Surg 2010;62:171–6
6 Maranhão, AS, Andrade, JS, Godofredo, VR, Matos, RC, Penido, Nde O. Intratemporal complications of otitis media. Braz J Otorhinolaryngol 2013;79:141–9
7 Dubey, SP, Larawin, V. Complications of chronic suppurative otitis media and their management. Laryngoscope 2007;117:264–7
8 Songu, M, Altay, C, Onal, K, Arslanoglu, S, Balci, MK, Ucar, M et al. Correlation of computed tomography, echo-planar diffusion-weighted magnetic resonance imaging and surgical outcomes in middle ear cholesteatoma. Acta Otolaryngol 2015;135:776–80
9 Pinar, E, Sadullahoglu, K, Calli, C, Oncel, S. Evaluation of prognostic factors and middle ear risk index in tympanoplasty. Otolaryngol Head Neck Surg 2008;139:386–90
10 Gülüstan, F, Aslan, H, Songu, M, Başoğlu, MS, Katılmış, H. Relationships between facial canal dehiscence and other intraoperative findings in chronic otitis media with cholesteatoma. Am J Otolaryngol 2014;35:791–5
11 Yetiser, S, Tosun, F, Kazkayasi, M. Facial nerve paralysis due to chronic otitis media. Otol Neurotol 2002;23:580–8
12 Savic, DJ, Djeric, DR. Facial paralysis in chronic suppurative otitis media. Clin Otolaryngol 1989;14:515–17
13 Kim, J, Jung, GH, Park, SY, Lee, WS. Facial nerve paralysis due to chronic otitis media: prognosis in restoration of facial function after surgical intervention. Yonsei Med J 2012;53:642–8
14 Quaranta, N, Cassano, M, Quaranta, A. Facial paralysis associated with cholesteatoma: a review of 13 cases. Otol Neurotol 2007;28:405–7
15 Cawthorne, T. Intratemporal facial palsy. Arch Otolaryngol 1969;90:789–99
16 Ikeda, M, Nakazato, H, Onoda, K, Hirai, R, Kida, A. Facial nerve paralysis caused by middle ear cholesteatoma and effects of surgical intervention. Acta Otolaryngol 2006;126:95100
17 Altuntas, A, Unal, A, Aslan, A, Ozcan, M, Kurkcuoglu, S, Nalca, Y. Facial nerve paralysis in chronic suppurative otitis media: Ankara Numune Hospital experience. Auris Nasus Larynx 1998;25:169–72
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 7
Total number of PDF views: 59 *
Loading metrics...

Abstract views

Total abstract views: 475 *
Loading metrics...

* Views captured on Cambridge Core between 19th December 2016 - 20th April 2018. This data will be updated every 24 hours.