Updates and Knowledge Gaps in Cholesteatoma Research

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2020

Background: Cholesteatoma is a common condition encountered by the otolaryngologist in the Indian subcontinent. Due to absence of pain in most patients, they may have advanced disease at presentation. Lack of awareness, long distance between the patient’s home and the treatment centre are also reasons for late presentation. Surgical management is the mainstay of treatment. The aim of this study was to retrospectively analyze the number of patients with advanced cholesteatoma, the extent of disease, and associated complications.Methods: Fifty one patients out of a total of 1132 patients with cholesteatoma presented with advanced disease in a tertiary referral centre between January 2010 to January 2020. The surgical issues in the management of the disease and the outcomes were studied. Results: Fifty one patients presented with extensive cholesteatoma in a tertiary referral centre. There were 33 males and 18 females in the study. Of fifty one patients, pediatric cholesteatoma was se...

Philippine Journal of Otolaryngology Head and Neck Surgery, 2021

Objective: To determine the stage of middle ear cholesteatoma of patients who underwent middle ear surgery at the Southern Philippines Medical Center from January to December 2019, based on European Academy of Otology and Neurotology / Japan Otological Society (EAONO/ JOS) system. Methods: Design: Case Series Setting: Tertiary Government Training Hospital Participants: A total of 42 charts were included in the study Results: Of the 42 cases evaluated, congenital cholesteatoma was seen in 4 while acquired cholesteatoma was noted in 38, (further subdivided into 34 retraction pocket cholesteatoma and 4 non-retraction pocket/traumatic cholesteatoma). A majority (57%) had Stage II cholesteatoma (mass occupying at least two sub-sites in the middle ear) at the time of surgery. Eight (19%) had stage I cholesteatoma (confined to one sub-site), five (12%) had stage III cholesteatoma evidenced by extracranial complications such as subperiosteal abscess and erosion of the semicircular canals. S...

PubMed, 2016

We conducted a retrospective study to evaluate the clinical properties and follow-up of patients with external ear canal cholesteatoma (EECC) who were treated conservatively. Our study group was made up of 15 patients-6 men and 9 women, aged 21 to 82 years (mean: 48). In addition to demographic data, we compiled information on presenting signs and symptoms, the location of the lesion, treatment, and follow-up. All EECCs occurred spontaneously, and all were limited to the temporal bone. Lesions were left-sided in 7 patients, right-sided in 7, and bilateral in 1. For purposes of defining the location of the lesions, the ear canal was divided into four quadrants: anterior, posterior, superior, and inferior. Temporal bone computed tomography (CT) and otomicroscopic evaluation revealed that 7 of the 16 lesions (44%) were located in the anterior and inferior quadrants, 6 (38%) in the inferior quadrant only, 2 (13%) in the anterior, inferior, and posterior quadrants, and 1 (6%) in the anterior quadrant only. Otorrhea was present in 7 of the 15 patients (47%), otalgia in 6 (40%), itching in 4 (27%), fullness in 2 (13%), and occlusion in 1 (7%); 3 patients (20%) were asymptomatic. All patients were treated with local debridement and aspiration under otomicroscopy, and they were followed up with repeat aspirations approximately every 10 weeks under microscopy. The duration of follow-up ranged from 6 to 75 months (mean: 41). At study's end, cholesteatoma had not progressed in any patient during follow-up, indicating that repeat aspirations and regular follow-up of limited EECC prevent recurrence of signs and symptoms and progression of the disease.

Military Medicine, 1978

CHOLESTEATOMA, a progressively enlarging accumulation of keratinizing squamous epithelium within the temporal bone, is a disease process which is of common interest to the pediatrician, family practitioner, and otologist. These lesions may be classified into congenital and acquired varieties,1,4,9 as noted in Table I. While the acquired types are relatively common, congenital cholesteatomas remain asymptomatic until erosion into important structures in the temporal bone, or secondary infection arouses suspicion of their presence. Those arising in the middle ear can frequently be diagnosed by otoscopy prior to the onset of significant destruction. Four cases of congenital cholesteatoma are reported. The diagnosis, pathophysiology, and management of this condition is reviewed in an effort to stimulate renewed awareness of congenital cholesteatoma, and facilitate early diagnosis and treatment prior to the development of extensive otologic disease. R~port of Cases Case J. A two year old male was referred for evaluation of recurrent episodes of bilateral, acute otitis media. There was no past history of otorrhea or hearing loss. Examination showed bilateral pearly white masses in the anterior-superior quadrant of each mesotympanum (Fig. 1). The tympanic membranes were intact, translucent and slightly retracted. Surgical exploration of the right middle ear disclosed an easily removable three to four mm spherical mass attached to the anterior portion of the neck of the malleus (Figs. 2 and 3). Six weeks later, surgical exploration of the left middle ear showed a similar lesion. Histological examination of both masses was compatible with the diagnosis of cholesteatoma. Case 2. A 26 month old male was referred because of an abnormal otologic examination. There were no symptoms of otologic disease. Examination revealed a white mass in the anterior-superior quadrant of the right mesotympanum. Surgical exploration disclosed a three to four mm mass attached to the undersurface of the tympanic membrane which was removed without difficulty. By histologic examination, the diagnosis was cholesteatoma. Case 3. A five year old male was referred in 1971 for an evaluation of serous otitis media. The tympanic membranes were intact, dull, and retracted. Pure tone audiometry showed a 25dB conductive loss in the right ear and 15dB loss in the left. Myringotomies were performed. Ten months later, hearing in the left ear deteriorated to a 53dB conductive loss. The tympanic membranes were opaque and tympanosclerotic, and myringotomies were again performed. Two years later, due to persistant conductive loss and "thickening" of the posterior-superior quadrant of the left tympanic mem-From the

The Laryngoscope, 2000

Cholesteatoma of the petrous bone extending into the intracranial region is an unusual occurrence. Most cases have been attributed to secondary extension of a primary epidermal blastomatous malformation of the temporal bone into the middle or posterior fossae. Within the past two and a half decades, intracranial extension of acquired aural cholesteatoma has been recognized as a likely alternative to this mechanism. Recent literature has rejoined this observation by considering both primary and secondary cholesteatoma of the petrous bone as a single group, petrosal cholesteatoma. The present study is presented to analyze the clinical presentation, imaging findings, and surgical treatment of six patients with acquired aural cholesteatoma extending into the intracranial region. Findings in this study are compared with the extant literature on congenital and acquired cholesteatoma of the petrous bone. This study proposes that petrosal cholesteatoma is a valid anatomical construct; however, the pathogenesis of petrosal cholesteatoma is still important in understanding the clinical presentation and management of cholesteatoma that extends beyond the usual confines of the middle ear and mastoid. Study Design: Retrospective case review conducted at a tertiary referral center. Methods: From 1985 to 1999, 477 patients were surgically treated for acquired aural cholesteatoma. Patients with intracranial extension of cholesteatoma were studied. Clinical presentation, imaging studies, operative findings, surgical treatment, and postoperative results were evaluated. Results: Six cases in a series of 477 patients with acquired aural cholesteatoma had intracranial extension of disease. In this series, the most frequent pathway for intracranial extension was supralabyrinthine through the supratubal recess into the middle cranial fossa. A less frequent pathway was via the retrofacial air cells into the posterior cranial fossa. Surgical access for removal of intracranial cholesteatoma was accomplished through several approaches including translabyrinthine, transcochlear, retrolabyrinthine, and middle cranial fossa. In two patients who had reoperation for possible residual disease, one was free of residual disease and one was found to have residual cholesteatoma in the region of the horizontal facial nerve. Conclusion: Acquired aural cholesteatoma can extend into either the middle or posterior cranial fossae. In this study, cholesteatoma extended into the middle fossa through the supratubal recess along the labyrinthine facial nerve and into or above the internal auditory canal. A less frequent path is through the retrofacial air cells into the posterior fossa. Intracranial acquired cholesteatoma is generally small and presents with complaints related to underlying otitis media rather than the neurological deficits that are often associated with primary petrous bone cholesteatoma. While computed tomography and magnetic resonance imaging are both required to differentiate congenital petrous cholesteatoma from other lesions of the petrous bone, computed tomography of the temporal bone is usually sufficient to diagnosis and define intracranial extension of acquired aural cholesteatoma. These lesions can be completely excised rather than exteriorized.

Journal of Armed Forces Medical College, Bangladesh, 2017

Introduction: Cholesteatoma is an abnormal accumulation of keratin-producing squamous epithelium in the middle ear, epitympanum, mastoid or petrous apex. It is a threedimensional epidermoid structure exhibiting independent growth, replacing middle ear mucosa, resorbing and replacing underlying bone. Although it is not a neoplastic lesion, it can be insidious and potentially dangerous to the patient. Objective: To find out the socio-demographic pattern, clinical presentation and complication of cholesteatoma. Materials and Methods: This prospective study of 50 cases was done in the Department of Otolaryngology and Head-Neck surgery, CMH, Dhaka adopting simple random sampling technique from July 2008 to Dec 2009. Data were collected by personal interview and clinical examination in a pre-designed data sheet and were analyzed by SPSS 20. Results: In this study, the highest number of patients (44%) was in the age group 11-20 years with a mean age of 17.2 years. Male were more affected (...

International Journal of Pediatric Otorhinolaryngology, 1991

Our clinical study includes 56 cases of cholesteatoma in children aged 3-14 years, treated in a 6-year period. Cholesteatoma was localized in attic (6 cases), in middle ear (6 cases), in attic plus middle ear (16 cases) and in attic + middle ear + mastoid (28 cases or 50% of the total number). In the surgical treatment combined approach tympanoplasty (intact canal wall technique) was used in 76.8%, radical tympanomastoidectomy in 16.1%, and other techniques in 7.1%. Intact ossicular chain was found in 25%. Reconstruction of the ossicular chain (including autograft, homograft and allograft material) was done in 59%, and the remaining 16% were treated by classic radical surgery. Hearing results: unchanged, 48%; improved, 45%; slightly worsened, 7%; and no dead ear. Recurrency in 31% is considerably higher as compared to 15% in adults found in another comparable study by us.

Revue de laryngologie - otologie - rhinologie

Etude clinico-radiologique de l'oreille controlatérale dans le cholestéatome acquis unilatéral A clinico-radiological study of the contralateral ear in acquired unilateral cholesteatoma A clinico-radiological study of the contralateral ear in acquired unilateral cholesteatoma, H. M. Khalil, M. A. Saleh et al.

International Congress Series, 2003

The causes of cholesteatoma development have been interpreted in different ways. The object of our study was to present the most frequent causes of recurring cholesteatomas on the basis of our investigations. The prospective study carried out at the Institute for Otorhinolaryngology and Maxillofacial Surgery included 120 patients treated surgically for cholesteatomas. Seventy-five patients were cured after the first operation, while 45 were reoperated after recurrent cholesteatoma. The modified student t test was used to establish the difference between statistically significant groups (small independent sample proportion). The cholesteatoma was often localized in attic (25.3%) and was spreading into antrum (28%). Another group of cholesteatoma was more frequently present in mesotympanum. The small marginal perforations in back quadrants were noted more frequently in the second group (26.7%). Likewise, 40% of the patients from this group had intact chain of auditory ossicles. Destruction of all three auditory ossicles was more often in the first group. Polypoid mucosa was less detected in the first group (18.7%) in relation to the second group (46.7%). Canal wall-up tympanoplasty was used more commonly in the second group of patients. In patients treated surgically for cholesteatoma, the recurrence of the condition may be caused by different factors such as development of cholesteatoma in posterior parts of cavum, polypoid mucosa, localization of cholesteatoma in meso-and retrotympanum and obscured cavity recesses, intact chain of auditory ossicles and the application of close tympanoplasty.

European Annals of Otorhinolaryngology, Head and Neck Diseases, 2012

Objectives: To assess paediatric cholesteatoma surgical management strategies, residual disease and recurrence rates and especially the medium-term auditory impact. Material and methods: Retrospective study of 22 cases of acquired middle ear cholesteatoma selected from a series of 77 children under the age of 16 operated for cholesteatoma between 1st January 2000 and 31st December 2003 on the basis of the following criteria: first-line surgical management with postoperative follow-up greater than four years. Surgical strategies, preoperative and postoperative (at 1 year and at the final visit) audiograms and residual disease and recurrence rates were analysed. Results: A canal wall up tympanoplasty was performed in 82% of cases as first-line procedure and a canal wall down tympanoplasty was performed in 32% of cases. Residual cholesteatoma was observed in 9% of cases and recurrent disease was observed in 18% of cases. The mean preoperative hearing loss was 26 dB with an air-bone gap of 23 dB with values of 26 dB and 20 dB respectively at the end of follow-up. The majority of children were operated by two-stage canal wall up tympanoplasty. Long-term hearing results remained stable and close to preoperative values. The recurrence rate (residual disease and relapse) was low (27%), as reported in the literature.