Management of advanced cholesteatoma: Madras ENT Research Foundation experience

Kiran Natarajan, Rahul Kurkure, Swathi ., Anubhav Shrivastava, Sowmya Gajapathy, Mohan Kameswaran


Background: Cholesteatoma is a common condition encountered by the otolaryngologist in the Indian subcontinent. Due to absence of pain in most patients, they may have advanced disease at presentation. Lack of awareness, long distance between the patient’s home and the treatment centre are also reasons for late presentation. Surgical management is the mainstay of treatment. The aim of this study was to retrospectively analyze the number of patients with advanced cholesteatoma, the extent of disease, and associated complications.

Methods: Fifty one patients out of a total of 1132 patients with cholesteatoma presented with advanced disease in a tertiary referral centre between January 2010 to January 2020. The surgical issues in the management of the disease and the outcomes were studied.  

Results: Fifty one patients presented with extensive cholesteatoma in a tertiary referral centre. There were 33 males and 18 females in the study. Of fifty one patients, pediatric cholesteatoma was seen in 6 patients. Hearing loss was the most common presentation. Facial palsy, labyrinthine fistula, dural involvement, internal auditory meatus involvement was noted in some patients. All patients underwent surgical management with good outcomes.

Conclusions: Advanced cholesteatoma is a dreaded disease that can result in various complications. Involvement of the facial canal, labyrinth, cochlea, dura, internal auditory meatus, internal carotid artery, jugular bulb, and sigmoid sinus involvement in the presence of extensive disease should be identified before surgery. Appropriate treatment with complete disease clearance can result in good outcomes.


Advanced cholesteatoma, Imaging, Complications

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Kuo CL, Shiao AS, Yung M, Sakagami M. Updates and Knowledge Gaps in Cholesteatoma Research. BioMed Res Int. 2015;2015:854024.

Pandya Y, Piccirillo E, Mancini F, Sanna M. Management of Complex Cases of Petrous Bone Cholesteatoma. Ann Otol Rhinol Laryngol. 2010;119(8):514-25.

Ikeda M, Nakazato H, Onoda K, Hirai R, Kida A. Facial nerve paralysis caused by middle ear cholesteatoma and effects of surgical intervention. Acta Oto-Laryngologica, 2006;126:95-100.

Letícia P. Rositoa S, Canalia I, Teixeiraa A, Silva MN et al. Cholesteatoma labyrinthine fistula: prevalence and impact. Braz J Otorhinolaryngol. 2019;85(2):222-7.

Geven LI, Mulder JS, Graamans K. Giant Cholesteatoma: Recommendations for Follow-up. Skull Base 2008;18(5):353-9.

Gresham T. Richter A, Kenneth H, Lee B. Management of advanced cholesteatoma Contemporary assessment and management of congenital cholesteatoma. Current Opinion in Otolaryngol Head Neck Surg. 2009;17:339-45.

Smith JA, Danner CJ. Complications of Chronic Otitis Media and Cholesteatoma. Otolaryngol Clin N Am. 2006;39:1237-55.

Moody MW, Lambert PR. Incidence of Dehiscence of the Facial Nerve in 416 Cases of Cholesteatoma. Otol Neurotol. 2007;28:400-4.

McGuire JK, Wasla H, Harris C, Copley GJ, Fagan JJ. Management of pediatric cholesteatoma based on presentations, complications, and outcomes. Int J Pediatr Otorhinolaryngol. 2016;80:69-73.

Barath K, Huber AM, Stampfli P, Varga Z, Kollias S. Neuroradiology of Cholesteatomas. Am J Neuroradiol. 2011;32:221-9.

Terrance P. McHugh. Intracranial cholesteatoma: A Case Report and Review: The Journal of Emergency Med. 2007;32(4):375-9.

Ho SY, Kveton JF. Efficacy of the 2-staged procedure in the management of cholesteatoma. Arch Otolaryngol Head Neck Surg. 2003;129(5):541-5.

Lin JC, Ho KY, Kuo WR, Wang LF, Chai CY, Tsai SM. Incidence of dehiscence of the facial nerve at surgery for middle ear cholesteatoma: Otolaryngol Head Neck Surg. 2004;131:452-6.

Magliulo G, Colicchio MG, Ciniglio M. Facial Nerve Dehiscence and Cholesteatoma. Annals of Otol, Rhinol Laryngol. 2011;120(4):261-7.

Siddiq MA, Hanu-Cernat LM, Irving RM. Facial palsy secondary to cholesteatoma: analysis of outcome following surgery. J Laryngol Otol. 2007;121:114-7.

Soda-Merhy A, Betancourt-Suarez MA. Surgical treatment of labyrinthine fistula caused by cholesteatoma. Otolaryngol Head Neck Surg. 2000;122:739-42.

Wang HM, Lin JC, Lee KW, Tai CF, Wang LF, Chang HM, et al. Analysis of Mastoid Findings at Surgery to Treat Middle Ear Cholesteatoma. Arch Otolaryngol Head Neck Surg. 2006;132:1307-10.

Nagel J, Wöllner S, Schürmann M, Brotzmann V, Müller J, Greiner JF, et al. Stem cells in middle ear cholesteatoma contribute to its pathogenesis. Scientific Reports. 2018;8:6204.