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Subtotal petrosectomy performed between 2005 and 2015 in a tertiary referral centre in the Netherlands:indications, outcome and follow-up

Presenting Author: Tom Crins

Published online by Cambridge University Press:  03 June 2016

Tom Crins ,
Mick Metselaar ,
Anne van Linge  and
Robert Jan Pauw
Tom Crins
Affiliation:
Erasmus MC
Mick Metselaar
Affiliation:
Erasmus MC
Anne van Linge
Affiliation:
Erasmus MC
Robert Jan Pauw
Affiliation:
Erasmus MC
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Abstract

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Learning Objectives: Subtotal petrosectomy is a ‘last resort’ type of surgery where complex anatomy in pathologic ears makes surgery difficult. In case of cholesteatoma, residual disease remains an issue, but as long as patients lack any complaints, follow-up with diffusion-weighted MRI may be acceptable.

Introduction: In chronic otitis media (COM) (with or without cholesteatoma) a subtotal petrosectomy can be a ‘last resort’ surgical treatment after multiple prior surgeries. Subtotal petrosectomy can also be used as part of a lateral skull base procedure or as a first stage preparation before cochlear implantation. This study describes the results of subtotal petrosectomies performed in our center between 2005 and 2015, mainly focussed on COM.

Methods: All patients who underwent a subtotal petrosectomy in our centre between 01-01-2005 and 01-03-2015 were included in this retrospective chart review. Patient characteristics, pre-operative complaints and indications for surgery were noted. The main outcome measure for COM patients was complete eradication of the disease and resolution of otorrhoea. Complications and number of necessary revision surgeries were noted.

Results: A total of 56 patients (57 ears) were identified. Indications for subtotal petrosectomy were chronic otitis media (COM) with cholesteatoma (n = 28), COM without cholesteatoma (n = 12), prior to cochlear implantation (n = 4), oncology (n = 7) and ‘other’ (including 2 cases of liquorrhoea) (n = 6). Of all COM cases (n = 40) 30 patients had otorrhoea prior to surgery. After surgery otorrhoea resolved in all 30 ears. In three out of four revisions residual cholesteatoma was found. Another 5 cases show a lesion with diffusion restriction on diffusion weighted MRI and are followed with sequential MRI's. Reported complications were transient infection (n = 7) and vertigo (n = 6). The median follow-up for all 40 COM cases was 18 months (0–106).

Conclusions: This study gives an insight into the results of subtotal petrosectomy in a tertiary referral centre in the Netherlands. Subtotal petrosectomy in patients with otorrhoea resulted in a dry ear in all 30 cases. Residual cholesteatoma was proven in 3 out of 28 cases.