Preservation of hearing in cholesteatomas with inner ear invasion

Two cases of inner ear destruction by cholesteatoma are presented. There was total demineralization of the cochlea in one and significant vestibular destruction in the other. Eradication and exteriorization of the disease was accomplished with preservation of hearing in both cases. Safe management was enhanced by aggressive infection control and accurate surgical planning aided by current imaging techniques. The factors which protect auditory function in these lesions remain unclear. However, the site and extent of the disease as well as local tissue reaction leading to separation of the inflammatory process from the sensory epithelium appear to play a significant role in preservation of hearing despite the presence of invasive, destructive disease.