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Cholesteatoma Decoded – Indian Scenario

Presenting Author: Jyoti Dabholkar

Published online by Cambridge University Press:  03 June 2016

Jyoti Dabholkar ,
Arpit Sharma ,
Jaini Lodha  and
Abhishek Kumar
Jyoti Dabholkar
Affiliation:
King Edward Memorial Hospital
Arpit Sharma
Affiliation:
King Edward Memorial Hospital
Jaini Lodha
Affiliation:
King Edward Memorial Hospital
Abhishek Kumar
Affiliation:
King Edward Memorial Hospital
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Abstract

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Learning Objectives: 1. Complete eradication of disease by adequate exposure, proper saucerisation of mastoid cavity, adequate lowering of the facial ridge and wide meatoplasty are four main principles for a dry cavity. 2. Obliteration in select cases is required to create an optimum sized cavity. 3. Hearing improvement, though secondary, is vital and should be attempted if eustachian tube function allows.

Introduction: Cholesteatoma continues to pose a significant challenge to otologic surgeons, especially in developing countries. Challenges include: advanced stage with extensive spread, complications at presentation and different degrees of expertise of treating physicians. Being a tertiary care centre, we are faced with above problems and revision surgeries. This study was conducted to understand the behavior of cholesteatoma, intraoperative findings and to assess results in terms of cavity status and hearing outcome.

Materials and methods: This prospective study was conducted at KEM Hospital, India in 216 patients operated from 2010 to 2013 by a single surgeon with 2.5 years follow-up. Patient demographics, intraoperative disease induced changes and postoperative outcomes were analyzed.

Results: Of the 216 patients, 119 had primary and 73 had secondary cholesteatoma. 24 patients were referred for residual/recurrent disease and 48 presented with one or more complications. Erosion of sinus plate was seen in 9 and dural plate in 16 cases. Sinodural angle was involved in 28, sinus tympani in 40 and facial recess in 45 cases. Facial nerve was dehiscent in 53 cases. All patients underwent canal wall down mastoidectomy as a rule. Mastoid obliteration was done in 40 cases. Hearing mechanism was reconstructed by tympanoplasty – type 3 (116), type 4 (38) and type 2 using autologous incus (32). 26 patients underwent staged procedure and 4 required cul-de-sac closure. Dry cavity was achieved by an average of 1.75 months. Recurrence was seen in 1 patient.

Conclusion: Complete eradication of disease by adequate exposure, proper saucerisation of mastoid cavity, adequate lowering of the facial ridge and wide meatoplasty are four main principles for a dry cavity. Obliteration in select cases is required to create an optimum sized cavity. Hearing improvement, though secondary, is vital and should be attempted if eustachian tube function allows. A good follow-up is always essential.