Audiologic results of surgery for cholesteatoma: short- and long-term follow-up of influential factors

Milan D Stankovic
Otology & Neurotology 2008, 29 (7): 933-40

OBJECTIVE: To review the audiologic results in a cohort of patients surgically treated for cholesteatoma.

STUDY DESIGN: Retrospective review of patient records.

SETTING: Tertiary referral center.

PATIENTS: A retrospective study of patients operated on for acquired middle ear cholesteatoma during the period 1990 to 2002 was performed. A total of 758 patients were followed during a short-term period, and 611 patients were followed during a long-term period. The patients were divided into 3 age groups: children, adolescents, and adults. The localization of cholesteatoma was classified as attic, sinus, or tensa.

INTERVENTIONS: Closed tympanoplasty was always performed as the single procedure of choice on all the children, and reoperation or conversion to open tympanoplasty was made later if needed. Adult patients were treated with single classic canal wall up, or wall down (CWD), according to the propagation of disease and condition of middle ear.

MAIN OUTCOME MEASURES: Preoperative and postoperative air-bone gap (ABG) and pure-tone average were compared after short-term and long-term follow-up.

RESULTS: Average hearing improvement (reduction of ABG) amounted 20.0 dB for short-term and deteriorated to 18.0 dB during long-term analysis for all the patients. Preoperative hearing level was significantly worse for CWD than for intact canal wall technique. The ABG closure was much better in the group with attic cholesteatoma. Both preoperative and postoperative hearing levels were worse for children than for adolescents or adults. Revision operations and bilateral cholesteatoma gave worse total postoperative hearing. The long-term results of primary operations, when recurrent cholesteatoma did not occur, were stable. Damage to auditory ossicles correlated well with total preoperative and postoperative results. The most hearing improvement was verified for the frequencies between 500 and 3,000 Hz, and there was no sensorineural hearing loss.

CONCLUSION: The audiologic results of cholesteatoma surgery are preserved during long-term follow-up. We found that recurrent cholesteatoma was associated with diminished postoperative hearing. Poorer preoperative hearing level, CWD tympanoplasty, younger age, bilateral cholesteatoma, and ossicular damage, as well as revision surgery, were associated with reduced gains in hearing with surgical management. Surgical experience was important for ICW technique and for advanced damage of auditory ossicles. Recurrent cholesteatoma resulted in significantly worse hearing results for each analyzed parameter.

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