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Current trends in managing complications of chronic otitis media with cholesteatoma

Presenting Author: Jyoti Dabholkar

Published online by Cambridge University Press:  03 June 2016

Jyoti Dabholkar ,
Arpit Sharma ,
Jaini Lodha ,
Nitish Virmani  and
Shruti Bansal
Jyoti Dabholkar
Affiliation:
King Edward Memorial Hospital
Arpit Sharma
Affiliation:
King Edward Memorial Hospital
Jaini Lodha
Affiliation:
King Edward Memorial Hospital
Nitish Virmani
Affiliation:
King Edward Memorial Hospital
Shruti Bansal
Affiliation:
King Edward Memorial Hospital
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Abstract

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Learning Objectives: 1. Complications secondary to cholesteatoma still remain a formidable challenge in developing countries. A high index of suspicion is necessary to prevent significant morbidity and mortality. 2. CT scan plays a pivotal role in diagnosis of both intracranial and extracranial complications. 3. While the initial management may differ, canal wall down mastoidectomy remains the most reliable surgical procedure in these patients.

Introduction: Complications secondary to cholesteatoma are associated with significant morbidity and mortality. Despite a significant decline in the incidence of these complications in developed countries, they still pose a considerable challenge in developing countries. The present study has been conducted to outline our experience in managing complications of cholesteatoma.

Materials and Methods: This study was a retrospective review at KEM Hospital, India of clinical charts of patients with cholesteatoma who had presented with clinical or radiological evidence of complications and had undergone surgical interventions between 2008 and 2013. Patient demographics, clinical course, investigations, management and postoperative outcomes were analyzed.

Results: Of the 469 patients that underwent surgery for cholesteatoma, complications were observed in 86 patients (18.33%). Intracranial complications included meningitis 1.06%, brain abscess 3.2%, sigmoid sinus thrombophlebitis 1.9% and subdural empyema 1.06%. Extracranial complications included labyrinthine fistula 4.6%, facial paralysis 2.9%, zygomatic abscess 0.4%, post-auricular abscess 6.39%, neck abscess 1.2% and labyrinthitis 0.2%. HRCT temporal bone and CT Brain with contrast was done to establish the diagnosis of these complications. With combined neurosurgical intervention for intracranial complications and canal wall down (CWD) mastoidectomy as the definitive procedure, complete eradication of cholesteatoma was achieved.

Conclusions: Complications secondary to cholesteatoma still remain a formidable challenge in developing countries. A high index of suspicion is necessary to prevent significant morbidity and mortality. CT scan plays a pivotal role in diagnosis of both intracranial and extracranial complications. While the initial management may differ, canal wall down mastoidectomy remains the most reliable surgical procedure in these patients.