Multi-operated cholesteatoma: when two surgeries are not enough

Area of Science:

• Otolaryngology
• Surgical Pathology
• Medical Imaging

Background:

• Residual and recurrent cholesteatoma (RRC) studies often focus on single relapses.
• Understanding risk factors for multiple surgeries is crucial for effective management.
• Assessing the functional impact of repeated surgeries on hearing is essential.

Purpose of the Study:

• To identify risk factors for patients requiring at least three surgeries for cholesteatoma eradication.
• To evaluate the functional impact of multiple surgeries on hearing outcomes.
• To investigate the characteristics of multi-residual and/or recurrent cholesteatoma (RRC).

Main Methods:

• Retrospective analysis of 27 patients who underwent 3 consecutive cholesteatoma surgeries (2006-2016).
• Comparison of multi-RRC cases with single-RRC and no-RRC groups (868 total patients).
• Analysis of patient age, cholesteatoma location, ossicular erosion, surgical type, and hearing function.

Main Results:

• Multi-RRC patients were significantly younger (13.1 years) compared to single-RRC (28.0) and no-RRC (38.5) groups.
• Combined attical and mesotympanic location (66%) and ossicular erosion were significantly more prevalent in multi-RRC cases.
• No significant hearing impact was observed between the first and third surgeries; shorter intervals between initial surgeries were noted for multi-RRC.

Conclusions:

• Combined attical and mesotympanic extension, ossicular erosion, and young age are critical indicators for multi-RRC.
• Delaying MRI and second-look surgeries may increase the risk of multi-RRC.
• Close monitoring and timely interventions are recommended for high-risk cholesteatoma patients.