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Recurrence rate of cholesteatoma with autoclaved incus autograft
1*ENT Department, James Cook University Hospital, Middlesbrough; and †ENT Department Darlington Memorial Hospital, Darlington County, Durham, United Kingdom.
Objective:
To study the long-term recurrence rate of cholesteatoma with autoclaved incus autograft.
Study Design:
Prospective observational study between 1994 and 2009. The incus remnants were autoclaved at 134°C for 24 minutes at 205 kPa. The mean follow-up duration was 65.5 months, with a minimum follow-up duration of 31 months and a maximum follow-up duration of 186 months.
Setting:
Secondary referral center in a district general hospital.
Patients:
Thirty-seven cases of cholesteatoma treated with canal wall down mastoidectomy with primary ossicular reconstruction with autoclaved incus autograft were included. The age range of the patients was from 11 years to 67 years. The mean age was 38 years. Fifty-four percent was male, and 46% was female.
Interventions:
Therapeutic and rehabilitative--to treat and improve the patients' hearing loss secondary to cholesteatoma by using autoclaved autologous incus.
Main Outcome Measures:
Primary end point is the recurrence rate of cholesteatoma with a mean follow-up period of more than 5 years. Secondary end point is the audiometric outcome with air-bone gap (ABG) and air conduction improvement.
Results:
No recurrence of cholesteatoma was observed. No graft extrusion was seen. Preoperative mean ABG was 29.8 dB. Postoperative mean ABG was 25.6 dB at the final review, with the air conduction improvement at final review at 4.2 dB.
Conclusion:
Autoclaving the incus remnant harvested from cholesteatomatous middle ear cleft is a safe and effective method to prepare an incus autograft for primary ossicular reconstruction.
