Abstract
Objective
To review the results of revision surgery for cholesteatoma.
Study design
Retrospective review of patient’s records.
Setting
Tertiary referral center.
Patients
A retrospective study of patients operated for acquired middle ear cholesteatoma during the period 1990–2002 was performed. A total of 758 patients were divided into two groups according to surgical experience, and followed during short-term and long-term period. The cholesteatoma was divided according to location, age of patients, status of auditory ossicles, and bilaterality of disease.
Interventions
The patients were treated with single canal wall up or wall down, according to the propagation of disease and condition of middle ear. The indications for the reoperations were: recurrent or residual cholesteatoma, resuppuration, and AB gap more than 20 dB.
Main outcome measures
Type of surgical therapy, localization of cholesteatoma, age of patients, revisions, bilaterality of disease, damage of auditory ossicles and learning curve were analyzed.
Results
The number of revision operations was reduced in the second period (from totally 24.3% to 16.4%). Closed technique gave a significantly lower rate of failure. For attic cholesteatoma, adults, bilateral disease, and ossicular damage the rate of revisions was significantly lower with surgical experience.
Conclusion
Surgical experience was important for reduction of reoperation rate for attic and sinus cholesteatoma, adults, bilateral cholesteatoma, and when closed technique is used.
1
Introduction
Successful tympanoossiculoplasty with resulting long-term stability in case of middle ear cholesteatoma can be a difficult task . Different prognostic factors for the success of these operations were found, such as: absent malleus handle and stapes suprastructure, mucosal fibrosis, drainage, revision ear surgery, and type of surgical procedure .
Long-term results after at least 10 years of follow-up of cholesteatoma surgery are rare, and insufficient references exist concerning preservation of anatomic and functional results of operations for cholesteatoma . It is generally accepted that the long-term results of tympanoplasty are not as good as the short-term results .
There are also not sufficient data concerning the influence of personal experience on the results of cholesteatoma surgery. Since the number of major otological procedures is consistent over the time the need for subspecialisation, and training of surgeons is needed . The tympanic membrane healing rate, as well as the recurrence rate of cholesteatoma, was much higher in patients operated on by trainees than those operated on by the faculty . Due to the high failure rate with canal wall up techniques in resident hands, it is recommended to perform canal wall down technique . However, temporal bone dissection courses and regular surgical instruction develop adequate surgical skills with good results .
In a previous study we documented the audiological results after short and long term follow up of cholesteatoma surgery and the influence of surgical experience on these results .
The aim of this study was to review the reoperations after cholesteatoma surgery analyzing factors of failure, and the influence of the learning curve on the reduction of such failure and the need for revision surgery.
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