Published: 2018-10-24

Surgical outcome in chronic otitis media with cholesteatoma

Shwetha .


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.


COM, Cholesteatoma, Hearing outcome, Residivism, Post-operative complications

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Browning GG, Weir J, Kelly G, Swan IRC. Chronic Otitis Media. In: Watkinson JC, Clarke RW, eds. Scott-Brown’s Otorhinolaryngology Head & Neck surgery. 8th edn. CRC Press; 2018: 977-983.

Abramson M. Cholesteatoma pathogenesis: evidence for the migration theory. In:McCabe B, Sade J, Abramson M, eds. Cholesteatoma. First International Conference. Aesculapis: Birmingham, 1977: 176-186.

Derlacki EL, Clemis JD. Congenital cholesteatoma of the middle ear and mastoid. Ann Otol Rhinol Laryngol. 1965;74:706-27.

Levenson MJ, Michaels L, Parisier SC, Juarbe C. Congenital cholesteatomas in children: an embryologic correlation. Laryngoscope 1988;98:949-55.

Levenson MJ, Michaels L, Parisier SC. Congenital cholesteatomas of the middle ear in children: origin and management. Otolaryngol Clin North Am. 1989;22:941-54.

Michaels L. Biology of cholesteatoma. Otolaryngol Clin North Am 1989;22:869-81.

Chole RA, Sudhoff HH. Chronic Otitis Media, Mastoiditis, and Petrositis. In: Niparko JK, eds. Cummings Otolaryngology Head and neck surgery. 5th edn. Elsevier mosby; 2010: 1963-1978.

Telian AS, Schmalbach CE. Chronic otitis media. In:Snow Jr JB, Ballenger JJ, eds. Ballenger’s Otorhinolaryngology Head and Neck surgery. 16th edn. Hamilton, Ontario: BC Decker; 2003: 261-290.

Meyer TA, Strunk Jr CL, Lambert PR. Cholesteatoma. In: Bailey BJ, Johnson JT, Newlands SD, eds. Head and Neck surgery – Otolaryngology, 4th edn. Lippincott Williams and Wilkins: 2083-2091.

Goycoolea MV. Mastoid and Tympanomastoid procedures in otitis media. Otolaryngol Clin North Am. 1999;32(3):515.

Lambert PR. Mastoidectomy. In: Niparko JK, eds. Cummings Otolaryngology Head and neck surgery. 5th edn. Elsevier mosby; 2010: 2009-2015.

Dodson EE, Hashisaki GT, Hobgood TC, Lambert PR. Intact canal wall mastoidectomy with tympanoplasty for cholesteatoma in children. Laryngoscope. 1998;108:977-83.

Molvaer O, Vallersnes F, Kringelbotn M. The size of the middle ear and the mastoid air cell. Acta Otolarygol (Stock). 1978;85:24-32.

Merchant SN, Rosowski JJ, McKenna MJ. Tympanoplasty:operative techniques. Otolaryngol Head Neck Surg. 2003;14:224-36.

Toner JG, Smyth GD. Surgical treatment of cholesteatoma:a comparison of three techniques. Am J Otol. 1990;11:247-9.

Tos M, Lau T. Late results of surgery in different cholesteatoma types. ORL J Otorhinolaryngol Relat Spec. 1989;51:33-49.