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Incidence of mastoidectomy among cholesteatoma patients in Denmark

Presenting Author: Bjarki Djurhuus

Published online by Cambridge University Press:  03 June 2016

Bjarki Djurhuus ,
Christine Pedersen ,
Line Grosfjeld  and
Christian Faber
Bjarki Djurhuus
Affiliation:
Zealand University Hospital
Christine Pedersen
Affiliation:
University of Southern Denmark
Line Grosfjeld
Affiliation:
University of Southern Denmark
Christian Faber
Affiliation:
Department of ENT Head & Neck Surgery, Odense University Hospital
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Abstract

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Objective:

  1. 1) To describe the incidence rate of first-time surgically treated middle ear cholesteatoma (STMEC1) in Denmark 1977–2015 and to estimate the proportion undergoing mastoidectomy.

  2. 2) To describe the recurrence rate after STMEC1 on Funen 1982–2015 taking surgical approach into consideration.

Methods: Cases of STMEC1 were identified by the use of the Danish National Hospital Register which also provided data on mastoidectomy. A change in incidence rate over time was examined using Poisson regression analysis.

For STMEC1s on Funen, the medical records were reviewed. The rate of recurrence was analyzed by the Kaplan Meier method and Cox regression analysis.

Results: A total of 16,475 STMEC1s were identified. Of these 4,416 (27%) were children (<16 years of age) and 12,059 (73%) were adults.

The incidence rate of STEM1 in adults was stable at 6–7 per 100,000 person years for the last couple of decades.

In children the incidence rate fell from 15 per 100,000 person years in 2002 to 7 per 100,000 person years in 2015.

The proportion undergoing mastoidectomy was stable (53% in children and 58% in adults).

The medical records from 1,003 patients with cholesteatoma (1,056 ears) were reviewed. The overall proportion of ears with recurrence was 38% in children and 14% in adults 5 years after primary surgery. Individuals without the need of mastoidectomy were at lowest risk of recurrence while individuals undergoing canal wall up (CWU) without obliteration had the highest risk of recurrence (58% in children and 20% in adults after 5 years). In children, CWU without obliteration was associated with a hazard ratio for recurrence of 1.9 (95% 1.2–3.0) when compared with CWU with obliteration.

Conclusion: The incidence rate of STMEC1 in children halved from 2002 to 2015. Compared with adults, children were at an increased risk of recurrence. In children treated with CWU, obliteration was associated with a significantly lower risk of recurrence compared with no obliteration.