Abstract
We reviewed the surgical results of ossicular chain-preserving tympanoplasty in patients with cholesteatoma, and evaluated the postoperative outcomes in terms of the hearing outcomes and risk of recurrence of cholesteatoma.
This study was performed on 66 patients with pars flaccida cholesteatoma who were treated by ossicular chain-preserving tympanoplasty (ossiculoplasty type I, 9 cases, type IIIr, 57 cases) from 1991 to 2015.
We examined the cumulative frequency of patients who showed good hearing outcomes by Kaplan-Meier survival curve analysis, and also assessed the ventilation route from the tympanic cavity/epitympanum to the mastoid antrum. Furthermore, we examined cases with recurrent/residual cholesteatoma.
The cumulative frequency of good hearing results was more than 85% in both patients treated by type I and type IIIr ossiculoplasty. However, the hearing prognosis was significantly poorer in patients who underwent type IIIr surgery, in which the incus was taken out temporarily and returned to its original position. There were blockages of the anterior and posterior ventilation routes even in patients with Stage Ib disease, which is represented by localized cholesteatoma. There were 4 cases with recurrent/residual cholesteatoma, including 2 cases of recurrent cholesteatoma and 1 case of residual cholesteatoma in the group that was treated by ossiculoplasty type I, and 1 case of recurrent cholesteatoma in the group that was treated by ossiculoplasty type IIIr.
In the case of ossicular chain-preserving tympanoplasty, it is necessary to pay sufficient attention to prevention of recurrent cholesteatoma. Even if the cholesteatoma is localized, it is important to ensure the existence of sufficient ventilation by temporarily cutting the incudostapedial joint and checking behind the space of the auditory ossicle.
