Postoperative Recurrent Cholesteatoma in Rural Versus Urban Populations

Area of Science:

• Otolaryngology
• Surgical Outcomes
• Public Health

Background:

• Chronic ear disease, including acquired cholesteatoma, poses challenges in rural settings due to limited healthcare access.
• Rural populations experience a high risk of cholesteatoma recurrence, necessitating effective treatment strategies.

Purpose of the Study:

• To investigate surgical outcome disparities in acquired cholesteatoma patients between rural and urban populations.
• To identify differences in recurrence rates, audiological results, and complications.

Main Methods:

• Retrospective case series analysis of 122 patients from a single otolaryngology practice (January 2011 - May 2017).
• Comparison of surgical outcomes, including residual cholesteatoma, number of surgeries, recurrence, air-bone gap, ossicular integrity, and complications, between rural and urban cohorts.

Main Results:

• Rural patients showed significantly higher rates of postoperative residual cholesteatoma (OR=8.667) and required more surgeries (OR=5.185).
• No significant differences were observed in recurrence risk, cholesteatoma size, complications, or audiological outcomes between groups.
• Privately insured patients underwent more second-look surgeries (OR=8.582).

Conclusions:

• Rural patients with acquired cholesteatoma have an increased risk of residual disease and require more surgical interventions compared to urban counterparts.
• Findings suggest a need for further multicenter, prospective studies to understand urban-rural disparities in surgical outcomes.
• Evidence Level: IV.