The contralateral ear in patients with middle ear cholesteatoma after long-term follow-up

We aimed to develop a strategy for long-term follow-up of the contralateral ear in patients with cholesteatoma and to determine if the patients' age at surgery for cholesteatoma affects the condition of the contralateral ear during this follow-up.

From May to November 1999, patients followed for previous cholesteatoma surgery were enrolled. The contralateral ears were examined by the senior author (Dr. Lien). The past otologic records were checked, especially for the condition of the contralateral ear. McNemar test was used to check the pre- and post-follow-up difference. Kaplan-Meier analysis was used to determine the long-term normal rate of initially normal contralateral ears. A log-rank test was used to detect the difference in such normal rate among different age groups.

A total of 75 patients were enrolled (47 females and 28 males). The average age at surgery was 38.1 years, and the mean follow-up period was 67.6 months. The normal rate of the contralateral ears was 60.0% at the beginning; and decreased to 50.7% (p = 0.065) at the end of the observation period. The average time for an initially normal contralateral ear to develop an abnormality was 108.9 months. The 5- and 10-year normal rates, calculated by the Kaplan-Meier analysis, were 86.8% and 80.1%. The group who underwent surgery for a cholesteatomatous ear when younger than 35 years had a better prognosis than patients who were older than 35 years at surgery in terms of the normal rate of the initially normal contralateral ears.

We emphasize the need for concern about the contralateral ear in patients with a cholesteatomatous ear. Long-term follow-up of more than 10 years is needed to detect any abnormalities early. Although younger patients had a better prognosis in the initially normal contralateral ear than older patients, this finding could be attributed to the fact that younger patients were alert to seek medical care earlier.