Outcomes After Surgery for Cholesteatoma of the Pars Flaccida

Abstract

The objectives of treatment of cholesteatoma associated with otitis media are complete removal of the middle ear lesions, prevention of recurrence, and hearing improvement, as reported in the past. Herein, we reviewed the data of patients who did not show hearing improvement, and patients who were diagnosed to have recurrence at the 2nd stage of surgery performed for obtaining hearing improvement. We set a target of 51 patients and 52 ears who underwent single surgery or staged surgery for cholesteatoma arising in the pars flaccida during the two-year period from November 2016 to November 2018 (all cases were operated by first author) and had undergone pure-tone audiometry a year after the surgery. The results showed that the success rate for hearing improvement was 80.4%. Of the 52 cases in the observation period in the present study, reformation recurrence was detected in only 1 case, and residual recurrence was detected in 2 cases. On the other hand, of the cases of recurrence diagnosed at the 2nd surgery (31 cases), reformation recurrence was detected in 10 cases, and residual recurrence in 13 cases. Residual recurrence at the 2nd surgery was more likely to be seen in cases in which the lateral aspect of the superior tympanic cavity had been reconstructed with bone pate. After we changed the reconstruction method from bone pate to sliced cartilage, the frequency of reformation recurrence obviously decreased. We consider that the cause of the reformation recurrence in the patients who undergo reconstruction using sliced cartilage is re-extension through the front portion of the cartilage. Therefore, we think that is important to tightly fill the gap between the reconstructed plate and the sliced cartilage during the initial surgery.