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Modern methods of chronic suppurative otitis media with cholesteatoma surgery

Presenting Author: Eugene V. Garov

Published online by Cambridge University Press:  03 June 2016

Eugene V. Garov ,
Andrey I. Kryukov ,
Alexey Ivoilov ,
Nadezhda G. Sidorina  and
Ekaterina E. Garova
Eugene V. Garov
Affiliation:
L.I. Sverzhevski Scientific Research Clinical Institute of Otorhinolaryngology of Moscow Municipal Health Department, Russia
Andrey I. Kryukov
Affiliation:
L.I. Sverzhevski Scientific Research Clinical Institute of Otorhinolaryngology of Moscow Municipal Health Department, Russia
Alexey Ivoilov
Affiliation:
L.I. Sverzhevski Scientific Research Clinical Institute of Otorhinolaryngology of Moscow Municipal Health Department, Russia
Nadezhda G. Sidorina
Affiliation:
L.I. Sverzhevski Scientific Research Clinical Institute of Otorhinolaryngology of Moscow Municipal Health Department, Russia
Ekaterina E. Garova
Affiliation:
L.I. Sverzhevski Scientific Research Clinical Institute of Otorhinolaryngology of Moscow Municipal Health Department, Russia
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Abstract

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Learning Objectives:

Goal: Choice of optimal variant of surgical intervention at middle ear cholesteatoma al-lowing to achieve curing and hearing improving (hearing keeping) effect at minimum surgical injury.

Materials and methods: 3,468 surgeries were performed on temporal bone structures, 2,415 (70%) of them were performed in patients with CTTSOM. Different variants of tympanop-lasty were performed in 1,708 (70.7%) of patients and treating surgeries with tympanoplasty at middle ear cholesteatoma were performed in 594 (24.6%) patients.

Results: Cholesteatoma surgery confirms predomination of using of “closed” (54.6%) and “semi-open” (41%) variants of surgery. Transchannel (intrameatal and endaural) method is ap-plied at limited cholesteatoma, and transmastoidal method is applied at advanced condition. Cholesteatoma relapses (up to 32%) at revision surgery after “closed” variants predefined the in-terest to “semi-open” methods, when posterior wall of external ear duct is removal for better treatment and the cavity created undergoes tympanoplasty and mastoidoplasty. Use of patient's material (fascia, gristle, periosteum and bone chips) at any variants of surgery provides rigidity of the constructions created to retraction and good adaptation in site of transplantation, as well as low cost of the method. Cholesteatoma in tympanic form is identified in 38% patients, that de-fines the necessity of early surgical intervention and careful revision of drum cavity. Choice of transchannel method and surgery only in scope of tympanoplasty is explained by its high effi-ciency in 92.4% patients with mesotympanitis.

Conclusions: Cholesteatoma of middle ear occurs at any form of CSOM. The choice of its successful surgical treatment is based on diagnostics combined with modern methods of veri-fication and use of efficient treating methods of surgery with elements of reconstruction of mid-dle ear structures.