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Fate of patients with bilateral cholesteatoma.

Abstract：

INTRODUCTION:This study was designed to assess the clinical and surgical findings and long-term results of therapy in patients treated for bilateral chronic cholesteatomatous otitis media. PATIENTS AND METHODS:A series of 54 patients who underwent mastoid surgery for bilateral acquired cholesteatoma were followed regularly for a mean of 7.9 years (range 2 to 21 years). Results of treatment were compared with the results obtained in 349 patients treated for unilateral acquired cholesteatoma with a mean follow-up of 6.7 years. Hearing level was defined as the mean air conduction threshold at frequencies of 0.5, 1, and 2 kHz. Audiograms obtained the day before operation and at last follow-up examination were used for comparison. Results were analyzed using the t test and chi 2 test. RESULTS:Patients with bilateral cholesteatoma were more likely to be men (60% v 61%) and young (28 years v 38 years). A majority of patients underwent canal wall down mastoidectomy. Seventy-three percent of patients had ossicular erosion. During follow-up, residual recurrent cholesteatoma was found in 8 ears (7.4%). This compared with a recurrence rate of 8.3% in patients with unilateral cholesteatoma. The mean postoperative air conduction threshold (46.1 dB) was similar to patients with unilateral cholesteatoma (46.6 dB). At last follow-up, 43% of patients with bilateral cholesteatoma had a hearing level of 30 dB or better in their best ear. No patient had bilateral anacusis. DISCUSSION:Cholesteatoma is a burdensome disease. Our 54 patients with bilateral cholesteatoma underwent a total of 125 surgical procedures. Acquired cholesteatoma has a great tendency to recur. Fortunately, this study shows that recurrence is not higher in a group of patients with bilateral cholesteatoma when compared with the unilateral group. Unfortunately, the fate of hearing in patients with bilateral cholesteatoma is not so favorable. Only 19% had hearing levels of 30 dB or better in both ears. Hearing levels of less than 40 dB in one ear was present in 34% of patients. Fortunately, there was no case with severe sensorineural hearing loss as a complication of surgery in the present series. This reflects great efforts directed at reduction of infection preoperatively, avoidance of ossicular manipulation, and preservation of cholesteatoma matrix over fistula when encountered.

journal_name

Am J Otolaryngol

journal_title

American journal of otolaryngology

authors

Vartiainen E

doi

10.1016/0196-0709(93)90010-5

subject

Has Abstract

pub_date

1993-01-01 00:00:00

pages

49-52

issue

eissn

0196-0709

issn

1532-818X

pii

0196-0709(93)90010-5

journal_volume

pub_type

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Fate of patients with bilateral cholesteatoma.