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Incidence, 10-year recidivism rate and prognostic factors for cholesteatoma

Published online by Cambridge University Press:  28 February 2017

A Britze ,
M L Møller  and
T Ovesen
A Britze*
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Aarhus Universitetshospital, Denmark
M L Møller
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Aarhus Universitetshospital, Denmark
T Ovesen
Affiliation:
Department of Clinical Medicine, Aarhus University, Denmark
*
Address for correspondence: Dr Anders Britze, Dept of Otorhinolaryngology – Head and Neck Surgery, Aarhus Universitetshospital, Norrebrogade 44, DK-8000 C, Denmark Fax: +45 7846 3194 E-mail: [email protected]
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Abstract

Objective:

Cholesteatoma patients have a high risk of recurrence with complications, and knowledge exchange is a prerequisite for improving treatment. This study aimed to apply appropriate statistics to provide meaningful and transferable results from cholesteatoma surgery, to highlight independent prognostic factors, and to assess the incidence rate.

Methods:

Incidence rates were assessed for the district of Aarhus, Denmark. From 147 patients operated on mainly with canal wall up mastoidectomies for debuting cholesteatomas, 10-year Kaplan–Meier recidivism rates were calculated and independent prognostic factors for the recidivism were identified by Cox multivariate regression analyses.

Results:

Incidence rate was 6.8 per 100 000 per year. The 10-year cumulative recidivism rate was 0.44 (95 per cent confidence interval, 0.37–0.53). Independent prognostic factors for the recidivism were: age below 15 years (hazard ratio = 2.2; p > z = 0.002), cholesteatoma localised to the mastoid (hazard ratio = 1.7; p > z = 0.04), stapes erosion (hazard ratio = 1.9; p > z = 0.02) and incus erosion (hazard ratio = 1.9; p > z = 0.04).

Conclusion:

The recidivism rate is influenced by several factors that are important to observe, both in the clinic and when comparing results from surgery.

Keywords

CholesteatomaRecurrenceIncidenceRisk FactorsAudiometry
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 4 , April 2017 , pp. 319 - 328
Copyright
Copyright © JLO (1984) Limited 2017 

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References

1 Babighian, G. Posterior and attic wall osteoplasty: hearing results and recurrence rates in cholesteatoma. Otol Neurotol 2002;23:14–17 CrossRefGoogle ScholarPubMed
2 Nyrop, M, Bonding, P. Extensive cholesteatoma: long-term results of three surgical techniques. J Laryngol Otol 1997;111:521–6CrossRefGoogle ScholarPubMed
3 Darrouzet, V, Duclos, JY, Portmann, D, Bebear, JP. Preference for the closed technique in the management of cholesteatoma of the middle ear in children: a retrospective study of 215 consecutive patients treated over 10 years. Am J Otol 2000;21:474–81Google ScholarPubMed
4 Djurhuus, BD, Faber, CE, Skytthe, A. Decreasing incidence rate for surgically treated middle ear cholesteatoma in Denmark 1977–2007. Dan Med Bull 2010;57:A4186 Google ScholarPubMed
5 Kemppainen, HO, Puhakka, HJ, Laippala, PJ, Sipila, MM, Manninen, MP, Karma, PH. Epidemiology and aetiology of middle ear cholesteatoma. Acta Otolaryngol 1999;119:568–72Google ScholarPubMed
6 Statistics Denmark. In: http://www.dst.dk/en [12 January 2016]Google Scholar
7 Gurgel, RK, Jackler, RK, Dobie, RA, Popelka, GR. A new standardized format for reporting hearing outcome in clinical trials. Otolaryngol Head Neck Surg 2012;147:803–7CrossRefGoogle ScholarPubMed
8 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Committee on Hearing and Equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. Otolaryngol Head Neck Surg 1995;113:186–7CrossRefGoogle Scholar
9 Rosenfeld, RM, Moura, RL, Bluestone, CD. Predictors of residual-recurrent cholesteatoma in children. Arch Otolaryngol Head Neck Surg 1992;118:384–91CrossRefGoogle ScholarPubMed
10 Roger, G, Denoyelle, F, Chauvin, P, Schlegel-Stuhl, N, Garabedian, EN. Predictive risk factors of residual cholesteatoma in children: a study of 256 cases. Am J Otol 1997;18:550–8Google ScholarPubMed
11 Stangerup, SE, Drozdziewicz, D, Tos, M, Hougaard-Jensen, A. Recurrence of attic cholesteatoma: different methods of estimating recurrence rates. Otolaryngol Head Neck Surg 2000;123:283–7Google ScholarPubMed
12 Parisier, SC, Hanson, MB, Han, JC, Cohen, AJ, Selkin, BA. Pediatric cholesteatoma: an individualized, single-stage approach. Otolaryngol Head Neck Surg 1996;115:107–14CrossRefGoogle ScholarPubMed
13 Tomlin, J, Chang, D, McCutcheon, B, Harris, J. Surgical technique and recurrence in cholesteatoma: a meta-analysis. Audiol Neurootol 2013;18:135–42CrossRefGoogle ScholarPubMed
14 Kerckhoffs, KG, Kommer, MB, van Strien, TH, Visscher, SJ, Bruijnzeel, H, Smit, AL et al. The disease recurrence rate after the canal wall up or canal wall down technique in adults. Laryngoscope 2016;126:980–7CrossRefGoogle ScholarPubMed
15 Gocmen, H, Kilic, R, Ozdek, A, Kizilkaya, Z, Safak, MA, Samim, E. Surgical treatment of cholesteatoma in children. Int J Pediatr Otorhinolaryngol 2003;67:867–72CrossRefGoogle ScholarPubMed
16 Lau, T, Tos, M. Cholesteatoma in children: recurrence related to observation period. Am J Otolaryngol 1987;8:364–75CrossRefGoogle ScholarPubMed
17 Soldati, D, Mudry, A. Cholesteatoma in children: techniques and results. Int J Pediatr Otorhinolaryngol 2000;52:269–76CrossRefGoogle ScholarPubMed
18 Vartiainen, E. Factors associated with recurrence of cholesteatoma. J Laryngol Otol 1995;109:590–2CrossRefGoogle ScholarPubMed
19 Darrouzet, V, Duclos, JY, Portmann, D, Bebear, JP. Preference for the closed technique in the management of cholesteatoma of the middle ear in children: a retrospective study of 215 consecutive patients treated over 10 years. Am J Otol 2000;21:474–81Google ScholarPubMed
20 Gristwood, RE, Venables, WN. Factors influencing the probability of residual cholesteatoma. Ann Otol Rhinol Laryngol 1990;99:120–3CrossRefGoogle ScholarPubMed
21 Ahn, SH, Oh, SH, Chang, SO, Kim, CS. Prognostic factors of recidivism in pediatric cholesteatoma surgery. Int J Pediatr Otorhinolaryngol 2003;67:1325–30CrossRefGoogle ScholarPubMed
22 Stangerup, SE, Drozdziewicz, D, Tos, M. Cholesteatoma in children, predictors and calculation of recurrence rates. Int J Pediatr Otorhinolaryngol 1999;49(suppl 1):S69–73 CrossRefGoogle ScholarPubMed
23 Iino, Y, Imamura, Y, Kojima, C, Takegoshi, S, Suzuki, JI. Risk factors for recurrent and residual cholesteatoma in children determined by second stage operation. Int J Pediatr Otorhinolaryngol 1998;46:57–65 CrossRefGoogle ScholarPubMed
24 McRackan, TR, Abdellatif, WM, Wanna, GB, Rivas, A, Gupta, N, Dietrich, MS et al. Evaluation of second look procedures for pediatric cholesteatomas. Otolaryngol Head Neck Surg 2011;145:154–60CrossRefGoogle ScholarPubMed
25 de Zinis, LO, Tonni, D, Barezzani, MG. Single-stage canal wall-down tympanoplasty: long-term results and prognostic factors. Ann Otol Rhinol Laryngol 2010;119:304–12CrossRefGoogle ScholarPubMed
26 De, CE, Marchese, MR, Scarano, E, Paludetti, G. Aural acquired cholesteatoma in children: surgical findings, recurrence and functional results. Int J Pediatr Otorhinolaryngol 2006;70:1269–73Google Scholar
27 Vercruysse, JP, De, FB, Somers, T, Casselman, J, Offeciers, E. Long-term follow up after bony mastoid and epitympanic obliteration: radiological findings. J Laryngol Otol 2010;124:37–43 CrossRefGoogle ScholarPubMed
28 Mercke, U. The cholesteatomatous ear one year after surgery with obliteration technique. Am J Otol 1987;8:534–6Google ScholarPubMed
29 Gantz, BJ, Wilkinson, EP, Hansen, MR. Canal wall reconstruction tympanomastoidectomy with mastoid obliteration. Laryngoscope 2005;115:1734–40CrossRefGoogle ScholarPubMed
30 Black, B, Gutteridge, I. Acquired cholesteatoma: classification and outcomes. Otol Neurotol 2011;32:992–5CrossRefGoogle ScholarPubMed
31 Kim, MB, Choi, J, Lee, JK, Park, JY, Chu, H, Cho, YS et al. Hearing outcomes according to the types of mastoidectomy: a comparison between canal wall up and canal wall down mastoidectomy. Clin Exp Otorhinolaryngol 2010;3:203–6CrossRefGoogle Scholar
32 Drahy, A, De, BA, Lerosey, Y, Choussy, O, Dehesdin, D, Marie, JP. Acquired cholesteatoma in children: strategies and medium-term results. Eur Ann Otorhinolaryngol Head Neck Dis 2012;129:225–9CrossRefGoogle ScholarPubMed
33 Nevoux, J, Roger, G, Chauvin, P, Denoyelle, F, Garabedian, EN. Cartilage shield tympanoplasty in children: review of 268 consecutive cases. Arch Otolaryngol Head Neck Surg 2011;137:24–9CrossRefGoogle ScholarPubMed
34 Martin, TP, Weller, MD, Kim, DS, Smith, MC. Results of primary ossiculoplasty in ears with an intact stapes superstructure and malleus handle: inflammation in the middle ear at the time of surgery does not affect hearing outcomes. Clin Otolaryngol 2009;34:218–24CrossRefGoogle Scholar
35 Nadol, JB Jr, Staecker, H, Gliklich, RE. Outcomes assessment for chronic otitis media: the Chronic Ear Survey. Laryngoscope 2000;110:32–5CrossRefGoogle ScholarPubMed
36 Jung, KH, Cho, YS, Hong, SH, Chung, WH, Lee, GJ, Hong, SD. Quality-of-life assessment after primary and revision ear surgery using the chronic ear survey. Arch Otolaryngol Head Neck Surg 2010;136:358–65CrossRefGoogle ScholarPubMed
37 Choi, SY, Cho, YS, Lee, NJ, Lee, J, Chung, WH, Hong, SH. Factors associated with quality of life after ear surgery in patients with chronic otitis media. Arch Otolaryngol Head Neck Surg 2012;138:840–5CrossRefGoogle ScholarPubMed
38 Harris, AT, Mettias, B, Lesser, TH. Pooled analysis of the evidence for open cavity, combined approach and reconstruction of the mastoid cavity in primary cholesteatoma surgery. J Laryngol Otol 2016;130:235–41CrossRefGoogle ScholarPubMed