Subtotal petrosectomy for extensive cholesteatoma: A case series from Japan

Subtotal petrosectomy (STP) is a standard procedure for intractable middle ear disease in Western countries, but reports from Japan are scarce. This report describes the clinical experience, patient characteristics, and surgical outcomes of STP at a tertiary center in Japan.

We retrospectively reviewed the medical records of all patients who underwent STP in our department between January 2018 and April 2022. We analyzed patient demographics, underlying pathology, preoperative findings, postoperative complications, and the cholesteatoma recurrence rate.

The cohort included 11 patients (7 male, 4 female) with a median age of 75 years. The primary indication was extensive cholesteatoma (11 cases), which was often complicated by dural exposure (6 cases) and labyrinthine fistula (6 cases). Postoperative complications occurred in 1 patient (9 %), who developed a fistula at the blind sac closure site. There were no instances of postoperative facial nerve palsy or inner ear complications. MRI surveillance revealed a residual cholesteatoma recurrence rate of 27 % (3 cases).

STP is an option for managing extensive primary cholesteatoma where hearing reconstruction is not feasible, particularly in the elderly population. However, the risk of residual cholesteatoma is significant, as evidenced by a 27 % recurrence rate in this series, and careful surgical indication is essential to avoid potential over-indication. This finding highlights the critical importance of meticulous surgical technique and rigorous postoperative imaging surveillance to ensure long-term disease control.