Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-23T13:29:42.005Z Has data issue: false hasContentIssue false
  • English
  • Français

Combined approach tympanoplasty for cholesteatoma: impact of middle-ear endoscopy

Published online by Cambridge University Press:  07 June 2007

M Barakate  and
I Bottrill
M Barakate
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, John Radcliffe Hospital, University of Oxford, UK
I Bottrill*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, John Radcliffe Hospital, University of Oxford, UK
*
Address for correspondence: Mr Ian Bottrill, Consultant Otologist, Department of Otolaryngology, West Wing, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The aims of this study were (1) to explore whether the experience at the Radcliffe Infirmary (Oxford, UK) supported the use of combined approach tympanoplasty for cholesteatoma, by determining the rate of disease at subsequent surgery, and (2) to assess whether this rate differed from findings reported elsewhere in the literature, possibly due to the effect of using an oto-endoscope.

Study design:

Retrospective case review, with data entered prospectively for operations performed by a single surgeon.

Setting:

Tertiary referral hospital.

Patients:

Between January 1998 and December 2004 inclusive, 66 patients underwent 68 primary procedures, with data available for all ‘second looks’.

Interventions:

Diagnostic and therapeutic operations for cholesteatoma were performed.

Main outcome measures:

All patients in this study attended follow up and underwent a second look operation, during which the rate of residual and recurrent cholesteatoma was determined. An oto-endoscope was used at all primary and subsequent surgery.

Results:

The mean interval between the first and second combined approach tympanoplasty procedures was 16 months, and that between the second and third such procedures was 19 months (10 patients). One patient underwent a fourth combined approach tympanoplasty procedure, 17 months after a third such procedure. The rate of cholesteatoma at second combined approach tympanoplasty was 20.6 per cent (14/68); this was judged to be residual in 10 ears (14.7 per cent) and to be recurrent, with the redevelopment of retraction pockets, in four ears (5.9 per cent). The rate of cholesteatoma at third combined approach tympanoplasty was 20 per cent (two of 10); of these two, one patient had a small pearl in the middle ear removed with the aid of a potassium titanyl phosphate laser. There was no disease present in one patient at a fourth combined approach tympanoplasty. Only four patients required a modified radical mastoidectomy.

Conclusion:

Cholesteatoma remains a disease with significant morbidity. Endoscope-assisted surgery may decrease the morbidity of second look surgery and may improve the clearance of disease in appropriately selected patients.

Keywords

Chronic Otitis MediaCholesteatomaOtologic Surgical ProceduresEndoscopy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 2 , February 2008 , pp. 120 - 124
Copyright
Copyright © JLO (1984) Limited 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 McKennan, KX. Endoscopic ‘second look’ mastoidoscopy to rule out residual epitympanic/mastoid cholesteatoma. Laryngoscope 1993;103:810–14CrossRefGoogle ScholarPubMed
2 McKennan, KX. Endoscopic transcutaneous mastoidectomy for evaluation of residual epitympanic/mastoid cholesteatoma. Am J Otol 1993;14:369–72Google ScholarPubMed
3 Sade, J. Treatment of cholesteatoma. Am J Otol 1987;8:524–33Google ScholarPubMed
4 Glasscock, ME, Miller, GM. Intact canal wall tympanoplasty in the management of cholesteatoma. Laryngoscope 1976;86:1639–57CrossRefGoogle ScholarPubMed
5 Sade, J, Berco, E, Brown, M. Results of mastoid operations in various chronic ear diseases. Am J Otol 1981;3:11–20Google ScholarPubMed
6 Bottrill, ID, Poe, DS. Endoscope-assisted ear surgery. Am J Otol 1995;16:158–63Google ScholarPubMed
7 Hamilton, JW. Efficacy of the KTP laser in the treatment of middle ear cholesteatoma. Otol Neurotol 2005;26:135–9CrossRefGoogle ScholarPubMed
8 Pfleiderer, AG, Ghosh, S, Kairinos, N, Chaudhri, F. A study of recurrence of retraction pockets after various methods of primary reconstruction of attic and mesotympanic defects in combined approach tympanoplasty. Clin Otol 2003;28:548–51CrossRefGoogle ScholarPubMed
9 Gristwood, RE, Venables, WN. Cholesteatoma and tympanosclerosis. In: Sadé, J, ed. Cholesteatoma and Mastoid Surgery, Amsterdam: Kugler publ, 1982;133–137.Google Scholar
10 Austin, DF. Single-stage surgery for cholesteatoma: an actuarial analysis. Am J Otol 1989;10:419–25Google ScholarPubMed
11 Duckert, LG, Makielski, KH, Helms, J. Management of anterior epitympanic cholesteatoma: expectations after epitympanic approach and canal wall reconstruction. Otol Neurotol 2002;23:8–13CrossRefGoogle ScholarPubMed
12 De la Cruz, A, Fayad, JN. Detection and management of childhood cholesteatoma. Pediatric Annals 1999;28:370–3CrossRefGoogle ScholarPubMed
13 Takahashi, H, Honjo, I, Naito, Y, Miura, M, Tanabe, M, Hasebe, S. Cause of posterior canal wall retraction after surgery from the viewpoint of mastoid conditions. Am J Otol 1998;19:131–5Google ScholarPubMed
14 Kapur, TR. Causes of failure of combined approach tympanoplasty in the treatment of acquired cholesteatomas of the middle ear and the mastoid. J Laryngol Otol 1995;109:710–12CrossRefGoogle ScholarPubMed
15 Stangerup, SE, Drozdziewicz, D, Tos, M, Trabalzini, F. Surgery for acquired cholesteatoma in children: long-term results and recurrence of cholesteatoma. J Laryngol Otol 1998;112:742–9CrossRefGoogle ScholarPubMed
16 Iino, Y, Imamura, Y, Kojima, C, Takegoshi, S, Suzuki, J-I. Risk factors for recurrent and residual cholesteatoma in children determined by second stage operation. Int J Pediatr Otorhinolaryngol 1998;46:57–65CrossRefGoogle ScholarPubMed
17 Syms, MJ, Luxford, WM. Management of cholesteatoma: status of the canal wall. Laryngoscope 2003;113:443–8CrossRefGoogle ScholarPubMed