Iatrogenic cholesteatoma: a tertiary referral center experience

To report and compare different etiopathogenic mechanisms for iatrogenic cholesteatoma formation together with their respective symptomatic onset, diagnostic latency, anatomical extension and surgical management.

A retrospective single-center cohort observational study was conducted on patients who presented history of previous otologic surgery and subsequent diagnosis of iatrogenic cholesteatoma and underwent revision otologic surgery between January 2014 and December 2023.

Seventeen cases of iatrogenic cholesteatoma were investigated. Previous otologic procedures included myringoplasty (10 cases, 58,8%), cochlear implantation (3 cases, 17,6%), tympanoplasty (3 cases, 17,6%), and subtotal petrosectomy associated with cochlear implantation (1 case, 5,9%). Three etiopathogenic mechanisms were identified: vascular strip displacement or incorrect management of external auditory canal skin flaps (76,5%), erosion of the posterior bony wall of the external auditory canal in canal wall up mastoidectomies for cochlear implantation (17,6%) and external auditory canal skin residuals in subtotal petrosectomy cavity (5,9%). Symptomatic onset was characterized by hearing loss and otorrhea. Mean diagnostic latency was 74 months (min 10 - max 190). Surgical management included canalplasty, canal wall up and canal wall down mastoidectomy, subtotal petrosectomy and subtotal petrosectomy with cochlear implant explantation and reimplantation. The mean follow-up time was 51,35 months (range 14-125 months).

Iatrogenic cholesteatoma is a potential complication of a large variety of otologic surgical approaches. The late symptomatic onset and the consequent long mean diagnostic latency of this pathology makes it mandatory to carry out an accurate follow-up even after routine surgical procedure.