Subtotal petrosectomy: a comprehensive review
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20261521Keywords:
Subtotal petrosectomy, Cholesteatoma, Blind sac closure, Cochlear implantationAbstract
Subtotal petrosectomy (STP) is usually recommended for extensive pathology confined primarily to middle ear and mastoid, particularly for treatment of a large post-surgical cavity. It has been associated with middle ear procedure with blind sac closure of the external auditory canal. The Eustachian tube is obliterated in STP. The cavity is obliterated with autologous abdominal fat soaked in antibiotic ear drops. The extended skull base procedures are also sometimes referred to as STP. Because STP offers the potential for a permanent recovery with radical temporal bone clearing, it makes it possible to treat a wide range of diseases. Additionally, STP has a very low risk of complications when used in conjunction with other surgical procedures. STP has gained popularity during the last few decades, and its indications have expanded as well. When treating a complex case of tympanomastoid cholesteatoma, STP is a very safe and effective surgical treatment since it offers radical clearance, which may result in a permanent cure. STP can also be safely combined with hearing implantation procedure. During cochlear implantation, STP has been demonstrated to be useful for making a sterile, closed-off environment in the middle ear and for providing great visualization.
References
Coker NJ, Jenkins HA, Fisch U. Obliteration of the middle ear and mastoid cleft in subtotal petrosectomy: indications, technique, and results. Ann Otol Rhinol Laryngol. 1986;95(1):5-11.
Immordino A, Oliva S, Immordino P, Sireci F, Lorusso F, Manzella R, et al. Managing Complex Chronic Otitis Media: Insights from Subtotal Petrosectomy with Blind Sac Closure. J Clin Med. 2025;14(24):8633.
Canzi P, Berrettini S, Albera A, Barbara M, Bruschini L, Canale A, et al. Current trends on subtotal petrosectomy with cochlear implantation in recalcitrant chronic middle ear disorders. ACTA Otorhinolaryngologica Italica. 2023;43(2):67.
Yung M, James A, Merkus P, Philips J, Black B, Tono T, et al. International Otology Outcome Group and the International Consensus on the Categorization of Tympanomastoid Surgery. J Int Adv Otol. 2018;14(2):216-26.
D’Angelo G, Donati G, Bacciu A, Guida M, Falcioni M. Subtotal petrosectomy and cochlear implantation. Acta Otorhinolaryngol Ital. 2020;40(6):450-6.
Liu Q, Feng G, Shang Y, Wang S, Gao Z. Vibrant soundbridge implantation: floating mass transducer coupled with the stapes head and embedded in fat. ORL J Otorhinolaryngol Relat. 2018;80(2):59-64.
Rambo JT. Musculoplasty: a new operation for suppurative middle ear deafness. Trans Am Acad Ophthalmol Otolaryngol. 1958;62(2):166-77.
Coker NJ, Jenkins HA, Fisch U. Obliteration of the middle ear and mas toid cleft in subtotal petrosectomy: indications, technique, and results. Ann Otol Rhinol Laryngol. 1986;95:5-11.
Han P, Yilala MH, Morelli L, Musumano L, Ferraro M, Lauda L, et al. Subtotal Petrosectomy in Middle Ear Surgery: Insights From 40 Years of Experience at “Gruppo Otologico”. Otol Neurotol. 2025;15:10-97.
Prasad SC, Roustan V, Piras G, Caruso A, Lauda L, Sanna M. Subtotal petrosectomy: surgical technique, indications, outcomes, and comprehensive review of literature. Laryngoscope. 2017;127(12):2833-42.
Nocini R, Soloperto D, Arietti V, De Cecco F, Fulco G, Monzani D, et al. Subtotal petrosectomy: pictorial review of clinical indications and surgical approach. Indian J Otolaryngol Head Neck Surg. 2024;76(1):224-36.
Schwab B, Kludt E, Maier H, Lenarz T, Teschner M. Subtotal petrosectomy and Codacs™: new possibilities in ears with chronic infection. Europ Arch Oto-Rhino-Laryngol. 2016;273(6):1387-91.
Velasco G, Alshaikh H, Lee CM, Jeon MC, Han JS, Seo JH, et al. Surgical outcomes of simultaneous subtotal petrosectomy and cochlear implantation: a single institutional study. Europ Arch Oto-Rhino-Laryngol. 2025;282(4):1791-9.
Eze N, Huber A, Schuknecht B. De novo development and progression of endolymphatic sac tumour in von hippel-lindau disease: an observational study and literature review. J Neurol Surg B Skull Base. 2013;74(5):259-65.
Swain SK, Lenka S, Dubey D, Jena PP. Microbiology of chronic otitis media-a review. DY Patil J Health Sci. 2022;10(2):67-72.
Grinblat G, Vlad D, Caruso A, Sanna M. Evaluation of subtotal petrosectomy technique in difficult cases of cochlear implantation. Audiol Neurotol. 2020;25(6):323-35.
Kurkure R, Rayamajhi P, Castellino A, Dharmarajan S, Dham R, Natarajan K, et al. Subtotal petrosectomy in cochlear implant surgery: our experience. Indian J Otolaryngol Head Neck Surg. 2020;72(3):320-5.
Sanna M, Fois P, Pasanisi E, Russo A, Bacciu A. Middle ear and mastoid glomus tumors (glomus tympanicum): an algorithm for the surgical management. Auris Nasus Larynx. 2010;37(6):661-8.
Swain SK. Current practices of canal wall up versus canal wall down mastoidectomy: a review. Int J Res Med Sci. 2024;12(8):3117-23.
Patnaik U, Prasad SC, Medina M, Al-Qahtani M, D’Orazio F, Falcioni M, et al. Long term surgical and hearing outcomes in the management of tympanomastoid paragangliomas. Am J Otolaryngol. 2015;36(3):382-9.
Senn P, Haeusler R, Panosetti E, Caversaccio M. Petrous bone cholesteatoma removal with hearing preservation. Otol Neurotol. 2011;32(2):236-41.
Branco P, Morais CP, Guincho J, Colaço T, Castelhano L, Correia F, et al. Subtotal petrosectomy-a tertiary center’s experience. Portuguese J Otorhinolaryngol Head Neck Surg. 2024;62(2):117-24.
Sakaida H, Takeuchi K. Subtotal petrosectomy for extensive cholesteatoma: A case series from Japan. Auris Nasus Larynx. 2026;53(1):13-8.
Canzi P, Berrettini S, Albera A, Barbara M, Bruschini L, Canale A, et al. Current trends on subtotal petrosectomy with cochlear implantation in recalcitrant chronic middle ear disorders. ACTA Otorhinolaryngol Italica. 2023;43(2): 67.
Swain SK. Attic retraction pocket: a review. Int J Otorhinolaryngol Head Neck Surg. 2024;10(5):606-11.
Free R, Falcioni M, Di Trapani G, Giannuzzi A, Russo A, Sanna M. The role of subtotal petrosectomy in cochlear implant surgery-a report of 32 cases and review on indications. Otol Neurotol. 2013;34:1033-40.
Koro E, Wales J, Werner M. Bone conduction implants and active middle ear implants for adults. Sci Prog 2025;108(1):368504251328010.
Swain SK. An unusual cause of hearing loss in a 7-year-old boy: a case report. DY Patil J Health Sci. 2024;12(3):102-4.
Bendet E, Cerenko D, Linder TE, Fisch U. Cochlear implantation after subtotal petrosectomies. Eur Arch Otorhinolaryngol. 1998;255(4):169-74.
Geerse S, de Haan RJ, Ebbens FA, de Wolf MJ, van Spronsen E. Surgical results and quality of life after subtotal petrosectomy. Europ Arch Oto-Rhino-Laryngol. 2023;280(1):61-8.
Swain SK. Psychosocial impact of chronic otitis media on quality of life-A review. J Indira Gandhi Institute Med Sci. 2023;9(2):106-10.
Hellingman CA, Logher JLE, Kammeijer Q, Waterval JJ, Ebbens FA, van Spronsen E. Measuring growth of residual cholesteatoma in subtotal petrosectomy. Acta Otolaryngol. 2019;139(5):415-20.
Jain J, Nahak B, Das A, Swain SK. Otological, Audiological, and Intraoperative Features in Patients Suffering from Conductive Type of Hearing Loss: A Cross-sectional Study. Matrix Science Med. 2025;9(4):103-7.
Downloads
Published
How to Cite
Issue
Section
