Abstract
Explorative surgery is recommended irrespective of patient age, if a physician questions the existence of congenital middle ear cholesteatoma in a patient. We use two different surgical procedures depending on the preoperative computed tomography (CT) findings. If preoperative CT shows pneumatization of tympanic attic and mastoid antrum, we apply the one-time closed method in the first stage. In cases without pneumatization of tympanic attic and mastoid antrum, staged tympanoplasty is selected, and silastic sheeting is used through the tympanic attic and mastoid antrum to the middle ear in the initial operation. If pneumatization can be created from the central tympanic cavity to the mastoid cavity, we might easily be able to detect residual cholesteatoma after surgery with postoperative CT.
We examined 40 patients (40 ears) with congenital cholesteatoma who underwent surgery over the past 10 years. We adopted the staging system proposed by Potsic et al. in 2002. Patients classified as Stage I, III and IV comprised 6, 27 and 7 cases, respectively. There were no Stage II patients. Planned staged tympanoplasty was conducted in 8 of 27 Stage III patients and in all 7 Stage IV patients. We could create pneumatization from the central tympanic cavity to the mastoid cavity in all patients. Residual cholesteatoma was found in 25.9% of Stage III and 71.4% of stage IV patients. The incidence of residual cholesteatoma increased as stage number increased. The rate of successful hearing improvement according to the criteria of the Japan Otological Society was 92% (33 of 36 ears).
