Fate of patients with bilateral cholesteatoma

This study was designed to assess the clinical and surgical findings and long-term results of therapy in patients treated for bilateral chronic cholesteatomatous otitis media.

A series of 54 patients who underwent mastoid surgery for bilateral acquired cholesteatoma were followed regularly for a mean of 7.9 years (range 2 to 21 years). Results of treatment were compared with the results obtained in 349 patients treated for unilateral acquired cholesteatoma with a mean follow-up of 6.7 years. Hearing level was defined as the mean air conduction threshold at frequencies of 0.5, 1, and 2 kHz. Audiograms obtained the day before operation and at last follow-up examination were used for comparison. Results were analyzed using the t test and chi 2 test.

Patients with bilateral cholesteatoma were more likely to be men (60% v 61%) and young (28 years v 38 years). A majority of patients underwent canal wall down mastoidectomy. Seventy-three percent of patients had ossicular erosion. During follow-up, residual recurrent cholesteatoma was found in 8 ears (7.4%). This compared with a recurrence rate of 8.3% in patients with unilateral cholesteatoma. The mean postoperative air conduction threshold (46.1 dB) was similar to patients with unilateral cholesteatoma (46.6 dB). At last follow-up, 43% of patients with bilateral cholesteatoma had a hearing level of 30 dB or better in their best ear. No patient had bilateral anacusis.

Cholesteatoma is a burdensome disease. Our 54 patients with bilateral cholesteatoma underwent a total of 125 surgical procedures. Acquired cholesteatoma has a great tendency to recur. Fortunately, this study shows that recurrence is not higher in a group of patients with bilateral cholesteatoma when compared with the unilateral group. Unfortunately, the fate of hearing in patients with bilateral cholesteatoma is not so favorable. Only 19% had hearing levels of 30 dB or better in both ears. Hearing levels of less than 40 dB in one ear was present in 34% of patients. Fortunately, there was no case with severe sensorineural hearing loss as a complication of surgery in the present series. This reflects great efforts directed at reduction of infection preoperatively, avoidance of ossicular manipulation, and preservation of cholesteatoma matrix over fistula when encountered.