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Hearing and ossicular chain preservation in cholesteatoma surgery

Published online by Cambridge University Press:  18 October 2010

R Obholzer ,
J Ahmed ,
F Warburton  and
M J Wareing
R Obholzer*
Affiliation:
Department of Otolaryngology Head and Neck Surgery, St Bartholomew's and the Royal London Hospital, London, UK
J Ahmed
Affiliation:
Department of Otolaryngology Head and Neck Surgery, St Bartholomew's and the Royal London Hospital, London, UK
F Warburton
Affiliation:
Joint Research and Development Office, St Bartholomew's and the Royal London Hospital, London, UK
M J Wareing
Affiliation:
Department of Otolaryngology Head and Neck Surgery, St Bartholomew's and the Royal London Hospital, London, UK
*
Address for correspondence: Mr Rupert Obholzer, 5 Little Saint Leonards, London SW14 7LT, UK Fax: (+44) (0)207 188 2206 E-mail: [email protected]
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Abstract

Objective:

To assess the hearing changes associated with sacrificing an intact ossicular chain during cholesteatoma surgery.

Methods:

We reviewed the operation notes of surgical procedures performed by the senior author between October 2000 and April 2006. Thirty-three cases were identified in which cholesteatoma surgery had been performed in the presence of a mobile, intact ossicular chain. One set of case notes was missing; therefore, 32 cases were included in the analysis. The ossicular chain was preserved in 17 cases (14 males and three females) and sacrificed in 15 (eight males and seven females).

Results:

At the first post-operative assessment, a median air–bone gap deterioration of 3.3 dB was seen in patients in whom the ossicular chain had been sacrificed, while a median air–bone gap improvement of 3.3 dB was seen in those in whom the chain had been preserved. However, multivariable logistic regression analysis suggested that this difference in hearing outcomes was due to pre-operative hearing status, and that preservation of the ossicular chain did not lead to a better outcome.

Conclusions:

In cholesteatoma surgery, there is at most a marginal benefit in preserving the ossicular chain. In the current study, the better hearing outcomes associated with preservation of the ossicular chain were accounted for by patients' better pre-operative hearing status. This study did not demonstrate a difference in residual disease rate, but was underpowered to do so.

Keywords

CholesteatomaHearingTympanoplastyOtologic Surgical Procedures
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 125 , Issue 2 , February 2011 , pp. 147 - 152
Copyright
Copyright © JLO (1984) Limited 2010

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References

1Saleh, HA, Mills, RP. Classification and staging of cholesteatoma. Clin Otolaryngol 1999;24:355–9CrossRefGoogle ScholarPubMed
2Black, B. Reporting results in ossiculoplasty. Otol Neurotol 2003;24:534–42CrossRefGoogle ScholarPubMed
3Black, B. Ossiculoplasty prognosis: the SPITE method of assessment. Am J Otol 1992;13:544–51Google ScholarPubMed
4Bruzzo, M, Chays, A, Magnan, J. Intact ossicular chain cholesteatoma: aspects and results of conservative surgery [in French]. Ann Otolaryngol Chir Cervicofac 1998;115:309–14Google ScholarPubMed
5Sakagami, M, Seo, T, Node, M, Fukazawa, K, Sone, M, Mishiro, Y. Cholesteatoma otitis media with intact ossicular chain. Auris Nasus Larynx 1999;26:147–51CrossRefGoogle ScholarPubMed
6Wullstein, H. Theory and practice of tympanoplasty. Laryngoscope 1956;66:1076–95CrossRefGoogle ScholarPubMed
7Blakley, S, Kim, S, VanCamp, M. Preoperative hearing predicts postoperative hearing. Otolaryngol Head Neck Surg 1998;119:559–63CrossRefGoogle ScholarPubMed
8Pennings, RJE, Cremers, CWRJ. Postauricular approach atticotomy: a modified closed technique with reconstruction of the scutum with cymbal cartilage. Ann Otol Rhinol Laryngol 2009;118:199–204CrossRefGoogle ScholarPubMed
9Roth, TN, Hausler, R. Inside-out technique cholesteatoma surgery: a retrospective long-term analysis of 604 operated ears between 1992 and 2006. Otol Neurotol 2008;30:59–63CrossRefGoogle Scholar
10Stankovic, MD. Audiologic results of surgery for cholesteatoma: short- and long-term follow-up of influential factors. Otol Neurotol 2008;29:933–40CrossRefGoogle Scholar
11Hamilton, J. The intact ossicular chain in cholesteatoma surgery. In: Huber, A, Eiber, A, eds. Middle Ear Mechanics in Research and Otology, Proceedings of the 4th International Symposium. Singapore: World Scientific Publishing, 2007;183–7CrossRefGoogle Scholar
12Browning, GG. Reporting the benefits from middle ear surgery using the Glasgow Benefit Plot. Am J Otol 1993;14:135–40Google ScholarPubMed
13Dornhoffer, JL, Colvin, GB, North, P. Evidence of residual disease in ossicles of patients undergoing cholesteatoma removal. Acta Otolaryngol (Stockh) 1999;119:89–92Google ScholarPubMed
14Hamilton, JW. Efficacy of the KTP laser in the treatment of middle ear cholesteatoma. Otol Neurotol 2005;26:135–9CrossRefGoogle ScholarPubMed
15Palva, T, Karja, J, Palva, A. High-tone sensorineural losses following chronic ear surgery. Arch Otolaryngol 1973;98:176–8CrossRefGoogle ScholarPubMed
16Hishizaki, K, Yuen, K, Ogawa, T, Nomiya, S, Okano, M, Fukushima, K. Laser-assisted tympanoplasty for preservation of the ossicular chain in cholesteatoma. Am J Otolaryngol 2001;22:424–7CrossRefGoogle Scholar