Learning Objectives:

Objective: The purpose of this study was to investigate the surgical intervention and hearing preservation of early primary acquired cholesteatoma.

Methods: A case of bilateral early primary acquired middle ear cholesteatoma was reported. The different operative management of each ear was reviewed. Postoperative effect and hearing outcome were followed up.

Result: A 27-year-old male complained of intermittent bilateral otorrhea for seven years. The pure tone audiometry was 22 dB for the right ear and 28 dB for the left. Based on clinical history combining with CT imaging, the patient was diagnosed with bilateral primary acquired cholesteatoma. The two ears were operated separately in 1-year interval.

At surgery of left side, the ossicular chain was wrapped around by cholesteatoma which involved the region inside the ossicular chain. Hence the incus and head of malleus was removed. Then partial ossicular replacement prosthesis (PORP) were used to reconstruct the left ossicular chain and the epitympanum was reconstructed with cartilages. For the right side, cholesteatoma was confined to the regions outside the ossicular chain. The incus and stapes were intact with good movement although the head of malleus was partly eroded. Therefore, the right ossicular chain was reserved and the epitympanum was reconstructed. The patient was followed up until 9 month after the last operation. No recurrence was found in either ear and the PTA was improved to 13 dB for the right side and 20 dB for the left.

Conclusion: For primary acquired cholesteatoma at early stage, there is possibility that hearing impairment was slight even though the lesions of middle ear already covered and eroded the ossicular chain. For these cases, surgical procedure to remove the cholesteatoma may result in further hearing loss, which lead to a dilemma for both doctors and patients.