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The treatment of cholesteatoma with intact ossicular chain

Presenting Author: Nicola Quaranta

Published online by Cambridge University Press:  03 June 2016

Nicola Quaranta ,
Francesco Barbara ,
Vito Pontillo  and
Valentina De Robertis
Nicola Quaranta
Affiliation:
University of bari
Francesco Barbara
Affiliation:
University of Bari
Vito Pontillo
Affiliation:
University of bari
Valentina De Robertis
Affiliation:
University of Bari
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Abstract

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Learning Objectives: To discuss the surgical treatment of cholesteatoma with intact ossicular chain.

Introduction: The primary goal of cholesteatoma surgery is complete eradication of the disease. The objective of this study is to compare the results obtaine in patients affected by cholesteatoma with intact ossicular chain and submtted to Bondy Modified radical Mastoidectomy (BMRM) and canal wall up tympanoplasty (CWUT).

Methods: 65 patients were treated: 30 with BMRM (group A) and 35 with CWUT(group B). Of these last, 27 have undergone single stage technique (20 transcanal approach, with mastoidectomy 7) and 8 second look technique (2 transcanal approaches, with mastoidectomy 6). The location and the extension of the cholesteatoma was considered. The anatomical and functional postoperative complications were recorded. Functional analysis was conducted by comparing the Air Bone Gap (ABG) pre- and postoperatily.

Results: As for the group A, 2 patients (6.66%) presented post-operative complications (3,33% vertigo, 3,33% tinnitus); 5 patients (16.67%) had late anatomical complications (3,33% retraction pocket, 3,33% epidermal cyst, 10% otorrhea). As for the B group, 2 patients (5.9%) had post-operative complications (2,85% vertigo, 2,85% tinnitus); 7 patients (20%) had anatomical complications (8,75% recurrent cholesteatoma, 8,75% retraction pocket, 2,86% otorrhea). Group A had a preoperative ABG of 11,79 ± 6,48 dB and post operative of 13,86 ± 9,03 dB; group B had a pre-operative ABG of 17.45 ± 9,18 dB and a postoperative of 19,53 ± 13,62 dB. One patient of the group A and one of the B presented a significant decline of bone conduction (>30 dB).

Conclusion: Both techniques lead to good anatomical and functional results. In case of cholesteatoma with intact chain, RMB is indicated in cholesteatoma spreading posteriorly, in antrum and mastoid, while CWUT in case of cholesteatoma located in epitympanum and mesotympanum.