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External auditory canal pathology and Cholesteatoma complication. Management

Presenting Author: Marcel Cosgarea

Published online by Cambridge University Press:  03 June 2016

Marcel Cosgarea ,
Alma Maniu  and
Violeta Necula
Marcel Cosgarea
Affiliation:
ENT Clinic Cluj- Napoca
Alma Maniu
Affiliation:
ENT Clinic Cluj- Napoca
Violeta Necula
Affiliation:
ENT Clinic Cluj- Napoca
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Abstract

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Learning Objectives:

External auditory canal (EAC) pathology very ofen is not a simple pathology. To resolve this ear problems : malfomations, infections, tumors etc., is necessary to have good medical and surgical knowledges. Cholesteatoma remains one of the most challenging ear diseases, its evolution leading sometimes to serious complications (facial palsy, vestibular disorders, meningitis, intracranial abscesses, sigmoid sinus thrombosis etc.). Surgical treatment is always required.

Methods: We reviewed the operative reports of 534 cases treated in the ENT clinic from Cluj between 1998–2005. Patients ages ranged from 3 to 81 years, with a mean age of 30. The surgical procedure was to follow the cholesteatoma extension from the tympanic cavity to mastoid cavity. We used for ossicular chain reconstruction incus body without osteitis, head of the malleus, and temporal cortical bone. For the reconstruction of the eardrum and the canal wall we used perichondrium, cartilage with perichondrium(palisade technique), or only cartilage. Patients with complications underwent the canal wall-down technique.

Results: Recurrence of supuration was noticed in 28% of cases, requiring a second intervention.

Hearing improvement was obtaind in 58% of cases, satisfactory results 19% of the patients, and 23% showed no improvement of the hearing.

The best outcomes in the hearing recovery were obtained by using the head of the malleus or the incus as a PORP prosthesis(40%). Tragal cartilage was used as the columella between the eardrum and the stapes with good results(15%). We also used temporal cortical bone grafts as TORP prosthesis with good results(13%).

Conclusions: In EAC deasthe infections need medical treatment , the tumours surgery and themalformation restoring of hearing and somtime of aesthetics surgery.

Reconstructive techniques using autologous materials proved to be valuable procedures for the recovery of the patients hearing.

The cholesteatoma must always be operated, the technique being individualized from case to case.