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Cholesteatoma recurrence after endoscopy assisted tympanoplasty

Presenting Author: Emilia Karchier

Published online by Cambridge University Press:  03 June 2016

Emilia Karchier ,
Kazimierz Niemczyk ,
Krzysztof Morawski  and
Robert Bartoszewicz
Emilia Karchier
Affiliation:
Medical University of Warsaw
Kazimierz Niemczyk
Affiliation:
Medical University of Warsaw
Krzysztof Morawski
Affiliation:
Medical University of Warsaw
Robert Bartoszewicz
Affiliation:
Medical University of Warsaw
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Abstract

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Learning Objectives: The endoscopically assisted surgery of the middle ear is widely used in the world for over 20 years. The aim of the study was to assess the application of this method in comparision to the standard microscopic tympanoplasty in terms of the tendency to recurrence of cholesteatoma.

The endoscopically assisted surgery of the middle ear is widely used in the world for over 20 years. The aim of the study was to compare the use of this method compared to the standard microscopic tympanoplasty in terms of the tendency to recurrence of cholesteatoma.

The study included 45 patients operated in the years 2009 to 2010 due to cholesteatoma. All patients had made canal wall up tympanoplasty with posterior tympanotomy and removing the cholesteatoma from the middle ear. Reconstruction of the tympanic membrane and ossicular chain were performed as needed. Additionally application of endoscope in study group allowed to visualize and removing of the matrix of cholesteatoma from the reccesses of the tympanic cavity. We compared the results of treatment of patients five years after the first operation.

To the study group were enrolled twenty-five patients and twenty to the control group. During five years after surgery, again we operated on sixteen subjects in the study group (66%) and ten from control group (50%). The reason of second-look procedure was uncontrollable retraction pocket or apparent recurrence in the pocket in six patients from the study group (24%) and in one case from the control group (5%). The further persons had carried out second-look tympanoplasty to check the tympanic cavity and to perform ossiculoplasty.

The presence of cholesteatoma during reoperation were found in nine individuals in the study group (37.5%) – six recurrences from the retraction pockets (24%) and three residual cholesteatoma in the recesses of tympanic cavity (12%). In the control group the cholesteatoma was found in only two cases (10%). The recurrence from the retraction pocket in one patient (5%) and the residual of cholesteatoma in one person (5%).

We conclude that developed otosurgical technique is the basis of the satisfactory results of treatment. Additional tool is not affected a in crucial way for improving results in terms of score of residual cholesteatoma.