Extensive intratemporal cholesteatomas: presentation, complications and surgical outcomes

The purpose of the study was to review the clinical features, complications, surgical management and post-operative outcomes of medially invasive extensive cholesteatomas and intracranial complications of cholesteatoma. The retrospective review was carried out at a tertiary referral center and included 20 patients presenting with extensive intratemporal cholesteatomas between 2011 and 2013. Inclusion criteria were involvement of the labyrinth, facial nerve, posterior fossa dura and intracranial complications. The mean age of the patients was 20 years. Profuse foul-smelling otorrhoea and severe otalgia/temporal headache were the most common presenting features. Intracranial complications were observed in nine patients, most commonly temporal lobe abscess; 14/20 patients exhibited profound hearing loss. One case exhibited massive labyrinthine petrous apex cholesteatoma. Labyrinthine destruction was seen in all cases of facial nerve involvement. Management of intracranial complications preceded canal wall-down mastoidectomy with or without partial labyrinthectomy and subtotal petrosectomy (transotic) with blind sac closure for petrous cholesteatoma. Facial nerve infiltration was observed in one case, whereas eight cases exhibited gross dehiscence of the fallopian canal. Disease clearance was complete in all cases with two mortalities in patients with intracranial complications. Post-operative course was uncomplicated in all other patients apart from a case of wound dehiscence. All patients remain disease free after a minimum and maximum follow-up of 6 months and 2 years, respectively. Extensive intratemporal cholesteatomas and intracranial complications caused by them continue to pose a challenge to the management of otitis media in the current era and merit early recognition, surgical management and follow-up.