Retraction pocket excision with cartilage grafting as a preventive surgery for cholesteatoma

The goal of the present study is to summarize our experience on surgical management of retraction pockets (RP) as a preventive tool against cholesteatomas.

Twenty-five ears have been followed up for a mean period of 6.16 ± 4.35 years (from 1 to 17 years). The sample presented a mean age of 47.56 ± 19.11 years (from 16 to 73 years). All patients underwent cartilage graft surgery. Furthermore 10 (40%) underwent tympanoplasty (TPL) type I, 14 (56%) TPL type II and 1 (4%) TPL type V.

Eleven ears (44%) showed cholesteatoma: all these cases were stage III according to Charachon staging, and stage IV or V according to Gersdorff classification. Twelve patients (48%) showed erosion of the ossicular chain. Of these, five were associated with cholesteatoma and seven only with retraction. The recurrence rate of cholesteatoma was 12%. None of the patients with a stage II or III RP (according to Gersdorff classification) developed cholesteatoma. The recurrence of RP was 0%.In regards to literature review, seven references were selected. These studies showed a success rate ranging from 79.1% to 88%, while recurrences of RP varied from 6.4% to 13%. Only one study specified a recurrence rate of cholesteatoma of 28%.

Surgical treatment of stages II and III RP is an effective tool to prevent cholesteatoma formation. The presence of keratin accumulation and cholesteatoma at the RP (stages IV and V, according to Gersdorff) are the real predictors of poor prognosis.