[Clinical assessment of patients with chronic otitis media with cholesteatoma]

We evaluated clinical features and treatment results of patients with chronic otitis media (COM) with cholesteatoma.

The study included 83 patients (53 males, 30 females; mean age 27.5 years; range 7 to 60 years) who were treated for COM with cholesteatoma. All patients underwent otoscopic examination, audiometric investigation, temporal bone computed tomography, and when necessary, cranial tomography. Open or closed mastoidectomy was performed depending on the extent of cholesteatoma and perioperative appearance of the ear.

Open- and closed-technique mastoidectomies were performed in 64 and 19 patients, respectively. Ossicular chain defects were observed in 90.3% of patients, and 9.7% had no detectable ossicular chain. Cranial complications were present in 28%. Of patients who had undergone open mastoidectomy, 75% had dry ears, 11% had recurrent ear discharge, and 14% required revision mastoidectomy because of recurrence. Of those who had been treated by closed-technique, 79% had dry ears, whereas 21% required revision mastoidectomy. Recurrent cholesteatoma was detected in 85% of patients during revision mastoidectomy.

We prefer open-technique mastoidectomy in chronic otitis media patients with extensive cholesteatoma, bone destruction, and hearing impairment. This choice mainly relies on the socioeconomic status of patients and difficulty in having patient compliance with follow-up controls.