Multistage treatment of middle ear cholesteatoma

Middle ear cholesteatoma is challenge for the otosurgeon. The creation of a dry, safe ear is the primary goal of the cholesteatoma surgical management. In many cases especially in children multistage treatment is needed and multiple operations may be required. Elimination of advanced cholesteatoma is almost always possible with CWD technique. In cases with radical mastoidectomy the posterior canal wall should be reconstructed. If it is not possible mastoid cavity obliteration in combination with tympanoplasty should be done. If it is not performed during the first operation, ossiculoplasty is an important part of a second-look surgery through endoscopic ear surgery, which is possible and have advantages in the hidden areas, like attic, supratubal recess and sinus tympani to diminish residual cholesteatoma. Cholesteatoma is an aggressive disease, however we follow-up each patient annualy for many years and observe additionally with DWI-MRT. Recurrence can occur long time after the initial surgical excision even in the otherwise asymptomatic patient, that wise mastoid cavity obliteration are designed for primary and revision surgery. In cases with posterior canal wall reconstruction or mastoid cavity obliteration “open” or “closed” technique should not be opposed anymore. We call this a concept of “individualized approach or adapted technique in cholesteatoma surgery”.

Publication History

Publication Date:
23 April 2019 (online)