Follow-up of cholesteatoma surgery: open versus closed tympanoplasty

Abstract

Background: There are no universally accepted opinions about the choice of surgical technique and outcome of surgery for cholesteatoma in different age groups and localizations.

Methods: A prospective study of 758 patients with cholesteatomas was performed. They were divided into three age groups: children younger than 9 years, adolescents aged 10-16 years, and adults. Cholesteatoma was classified as: attic, sinus and tensa cholesteatoma. Classical canal wall-up or wall-down tympanoplasty was performed in all the cases, and reoperation was done later if needed. Anatomical and functional results were followed up regularly, and evaluated 3 years after the operations.

Results: During the postoperative course, after 3 years, retraction of the neomembrane was found in 23.8% of younger children, 27.6% of adolescents, and in 9.9% of adults. Recurrent cholesteatomas were more than twice as frequent in children (19.0%) as in adults (9.4%). Reoperation was performed in 38.1% of children and in 9.4% adults. In one fourth of pediatric cholesteatoma reoperations, conversion to open tympanoplasty was done. Retraction and recurrent disease were present in about 10% of attic and sinus cholesteatomas, and in 15.5% of tensa cholesteatomas.

Conclusion: Postoperative audiological results of cholesteatoma surgery in children are comparable to adults. Retraction pockets, recurrent cholesteatomas and reoperations are twice as frequent in the pediatric group as in adults. The worst anatomical and functional results are achieved in tensa cholesteatomas. The age of the patient and localization of cholesteatoma are very important factors that determine the type of surgical procedure and the results of surgery for middle ear cholesteatoma. A closed technique is better for attic and sinus cholesteatomas, while in tensa cholesteatomas, an open technique seems more appropriate.