Surgical outcome in chronic otitis media with cholesteatoma

Abstract

Background: Cholesteatoma is synonymous with active squamous type of disease where there is retraction of pars flaccida or tensa that has retained squamous epithelial debris and is associated with inflammation and the production of pus. This pathology can only be eradicated by meticulous surgery. Our study compares the surgical outcome of intact canal wall vs. canal wall down surgeries done for cholesteatoma.

Methods: Prospective study on 42 patients who underwent surgery for cholesteatoma between December 2010 and March 2013 at VIMS, Bellary.  

Results: The net improvement in ABG in ICW mastoidectomy was 16.03 (±7.5) dB and that in CWD mastoidectomy was 11.39(±7.4) dB with a significant p value of 0.04 as determined by the independent ‘t’ test. The residual disease rate for ICW mastoidectomy was determined as 12% whereas recurrence rate was nil. CWD mastoidectomy had no residual or recurrent disease in the 6-month follow-up period. Postoperative complications were noted in 15% of the study population.

Conclusions: The ICW and CWD surgeries have their own advantages and disadvantages and when performed meticulously both serve the purpose of rendering the patient a safe ear. The ICW procedure leaves behind an anatomically near normal ear and when quality of life concerns needs to be addressed this should be the procedure of choice, with advancement in technology and availability of angled endoscopes which have marched well into otology. The CWD procedure should be reserved to cases presenting with complications and in patients who are more likely to be lost to follow-up.