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Pooled analysis of the evidence for open cavity, combined approach and reconstruction of the mastoid cavity in primary cholesteatoma surgery

Published online by Cambridge University Press:  15 February 2016

A T Harris ,
B Mettias  and
T H J Lesser
A T Harris
Affiliation:
ENT department, Aintree University Hospital, Liverpool, UK
B Mettias
Affiliation:
ENT department, Aintree University Hospital, Liverpool, UK
T H J Lesser*
Affiliation:
ENT department, Aintree University Hospital, Liverpool, UK
*
Address for correspondence: Mr T H J Lesser, ENT Department, Aintree University Hospital, Lower Lane, Liverpool L9 7AL, UK E-mail: tristram.lesser@aintree.nhs.uk
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Abstract

Background:

Cholesteatoma is keratinising epithelium within the middle-ear cleft or mastoid. This disease destroys the peripheral organs of balance and hearing, with possible intracranial sequelae. The management of cholesteatoma is surgical and the primary aim is to remove the disease and prevent recurrence. Secondary aims are to obtain a non-discharging, hearing ear. Cholesteatoma surgery falls into two broad categories: open cavity surgery and combined approach surgery. A third surgical category is reconstruction of an open mastoid cavity after open surgery. This study performed a pooled analysis of the worldwide literature to compare the rates of cholesteatoma not being cured (i.e. recidivism), ear discharge and hearing change among open cavity, combined approach and reconstruction mastoid surgery for primary cholesteatoma.

Methods:

A literature search for all types of cholesteatoma surgery in the PubMed, Google Scholar and Medline databases and in published conference proceedings was undertaken.

Results:

There was no level 1 evidence for the best method of primary cholesteatoma surgery. The highest evidence level found (level 2; 5366 patients) shows no difference in hearing change or discharge rate between open and combined approach surgery; however, these methods fail to cure the cholesteatomas in 16.0 per cent and 29.4 per cent of cases, respectively. In a total of 640 patients, reconstruction and/or repair mastoid surgery using a variety of non-comparable techniques had a failure rate of between 5.3 per cent and 20 per cent.

Conclusion:

The available evidence suggests that reconstruction of the posterior canal wall and/or obliteration of the mastoid may be the best surgical treatment alternative. This technique appears to provide the lowest recidivism rate combined with a low post-operative ear discharge rate.

Keywords

CholesteatomaMastoid SurgeryHearing
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 130 , Issue 3 , March 2016 , pp. 235 - 241
Copyright
Copyright © JLO (1984) Limited 2016 

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References

1Ojala, K, Palva, A.Late results of obliterative cholesteatoma surgery. Arch Otolaryngol 1982;108:1–3CrossRefGoogle ScholarPubMed
2Patient: trusted medical information and support, 2011 Different levels of evidence. In: http://www.patient.co.uk/doctor/different-levels-of-evidence [24 July 2015]Google Scholar
3Lau, T, Tos, M.Tensa retraction cholesteatoma: treatment and long-term results. J Laryngol Otol 1989;103:149–57CrossRefGoogle ScholarPubMed
4Zorita, C, Villar, J, Bosch, J.Long-term results of cholesteatoma surgery in children. Acta Otorrinolaringol Esp 1994;45:233–6Google ScholarPubMed
5Stangerup, SE, Drozdziewicz, D, Tos, M, Trabalzini, F.Surgery for acquired cholesteatoma in children: long-term results and recurrence of cholesteatoma. J Laryngol Otol 1998;112:742–9CrossRefGoogle ScholarPubMed
6Godinho, RA, Kamil, SH, Lubianca, JN, Keogh, IJ, Eavey, RD.Pediatric cholesteatoma: canal wall window alternative to canal wall down mastoidectomy. Otol Neurotol 2005;26:466–71CrossRefGoogle ScholarPubMed
7Derlacki, EL, Baron, HS, Beales, PH, Bellucci, RJ, Guilford, FR, Plester, D et al. Selection of closed vs open technique for cholesteatomas. Arch Otolaryngol Head Neck Surg 1969;89:211–19CrossRefGoogle Scholar
8Deguine, C.Longterm results in cholesteatoma surgery. Clin Otolaryngol Allied Sci 1978;3:301–10CrossRefGoogle ScholarPubMed
9Brown, JS.A ten year statistical follow-up of 1142 consecutive cases of cholesteatoma: the closed vs. the open technique. Laryngoscope 1982;92:390–6CrossRefGoogle Scholar
10Charachon, R.Surgery of cholesteatoma in children. J Laryngol Otol 1988;102:680–4CrossRefGoogle ScholarPubMed
11Quaranta, A, Cassano, P, Carbonara, G.Cholesteatoma surgery: open vs closed tympanoplasty. Am J Otol 1988;9:229–31Google ScholarPubMed
12Marco-Algarra, J, Gimenez, F, Mallea, I, Armengot, M, de la Fuente, L.Cholesteatoma in children: results in open versus closed techniques. J Laryngol Otol 1991;105:820–4CrossRefGoogle ScholarPubMed
13Schmid, H, Dort, JC, Fisch, U.Long-term results of treatment for children's cholesteatoma. Am J Otol 1991;12:83–7Google ScholarPubMed
14Vartiainen, E, Nuutinen, J.Long-term results of surgical treatment in different cholesteatoma types. Am J Otol 1993;14:507–11Google ScholarPubMed
15Karmarkar, S, Bhatia, S, Saleh, E, DeDonato, G, Taibah, A, Russo, A et al. Cholesteatoma surgery: the individualized technique. Ann Otol Rhinol Laryngol 1995;104:591–5Google ScholarPubMed
16Parisier, SC, Hanson, MB, Han, JC, Cohen, AJ, Selkin, BA.Pediatric cholesteatoma: an individualized, single-stage approach. Otolaryngol Head Neck Surg 1996;115:107–14CrossRefGoogle ScholarPubMed
17Roden, D, Honrubia, VF, Wiet, R.Outcome of residual cholesteatoma and hearing in mastoid surgery. J Otolaryngol 1996;25:178–81Google ScholarPubMed
18Dodson, EE, Hashisaki, GT, Hobgood, TC, Lambert, PR.Intact canal wall mastoidectomy with tympanoplasty for cholesteatoma in children. Laryngoscope 1998;108:977–83CrossRefGoogle ScholarPubMed
19Darrouzet, V, Duclos, JY, Portmann, D, Bebear, JP.Preference for the closed technique in the management of cholesteatoma of the middle ear in children: a retrospective study of 215 consecutive patients treated over 10 years. Am J Otol 2000;21:474–81Google ScholarPubMed
20Rondini-Gilli, E, Mosnier, I, Julien, N, Gouin, JM, Aïdan, P, Rufat, P, Sterkers, O.One-stage surgery of middle ear cholesteatoma in adults: apropos of 180 cases. Rev Laryngol Otol Rhinol (Bord) 2001;122:75–9Google ScholarPubMed
21Göçmen, H, Kiliç, R, Ozdek, A, Kizilkaya, Z, Safak, MA, Samim, E.Surgical treatment of cholesteatoma in children. Int J Pediatr Otorhinolaryngol 2003;67:867–72CrossRefGoogle ScholarPubMed
22Siddiqui, R.Surgery for otitis media with cholesteatoma: canal up versus canal down procedures. Liaquat J Uni Med Health Sci 2005;44:64–7Google Scholar
23Shirazi, MA, Muzaffar, K, Leonetti, JP, Marzo, S.Surgical treatment of pediatric cholesteatomas. Laryngoscope 2006;116:1603–7CrossRefGoogle ScholarPubMed
24Tos, M.Modification of combined-approach tympanoplasty in attic cholesteatoma. Arch Otolaryngol 1982;108:772–8CrossRefGoogle ScholarPubMed
25Lesinskas, E, Vainutiene, V.Closed tympanoplasty in middle ear cholesteatoma surgery. Medicina (Kaunas) 2004;40:856–9Google ScholarPubMed
26Sanna, M, Zini, C, Gamoletti, R, Delogu, P, Russo, A, Scandellari, R, Taibah, A.The surgical management of childhood cholesteatoma. J Laryngol Otol 1987;101:1221–6CrossRefGoogle ScholarPubMed
27Ojala, K, Palva, A.Late results of obliterative cholesteatoma surgery. Arch Otolaryngol 1982;108:1–3CrossRefGoogle ScholarPubMed
28Barakate, M, Bottrill, I.Combined approach tympanoplasty for cholesteatoma: impact of middle-ear endoscopy. J Laryngol Otol 2008;122:120–4CrossRefGoogle ScholarPubMed
29He, Y, Liang, Y, Liu, X, Li, G, Hu, Y.Intact canal wall mastoidectomy and tympanoplasty in treating patients with cholesteatoma of the middle ear and mastoid [in Chinese]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2008;22:740–1Google ScholarPubMed
30Hinohira, Y, Yanagihara, N, Gyo, K.Improvements to staged canal wall up tympanoplasty for middle ear cholesteatoma. Otolaryngol Head Neck Surg 2007;137:913–17CrossRefGoogle ScholarPubMed
31Ho, SY, Kveton, JF.Efficacy of the 2-staged procedure in the management of cholesteatoma. Arch Otolaryngol Head Neck Surg 2003;129:541–5CrossRefGoogle ScholarPubMed
32Quaranta, N, Fernandez-Vega Feijoo, S, Piazza, F, Zini, C.Closed tympanoplasty in cholesteatoma surgery: long-term (10 years) hearing results using cartilage ossiculoplasty. Eur Arch Otorhinolaryngol 2001;258:20–4CrossRefGoogle ScholarPubMed
33Mutlu, C, Khashaba, A, Saleh, E, Karmarkar, S, Bhatia, S, DeDonato, G et al. Surgical treatment of cholesteatoma in children. Otolaryngol Head Neck Surg 1995;113:56–60CrossRefGoogle ScholarPubMed
34Schwaber, MK.Intact canal wall mastoidectomy. Am J Otol 1979;1:45–8Google ScholarPubMed
35Sun, J, Sun, J, Hu, Y, Lv, Q, Wang, Y, Li, X, et al. Canal wall-down mastoidectomy with mastoid obliteration for pediatric cholesteatoma. Acta Otolaryngol 2010;130:259–62CrossRefGoogle ScholarPubMed
36Redaelli de Zinis, LO.Titanium vs hydroxyapatite ossiculoplasty in canal wall down mastoidectomy. Arch Otolaryngol Head Neck Surg 2008;134:1283–7CrossRefGoogle ScholarPubMed
37Ajalloueyan, M.Experience with surgical management of cholesteatomas. Arch Otolaryngol Head Neck Surg 2006;132:931–3CrossRefGoogle ScholarPubMed
38Mukherjee, P, Saunders, N, Liu, R, Fagan, P.Long-term outcome of modified radical mastoidectomy. J Laryngol Otol 2004;118:612–16CrossRefGoogle ScholarPubMed
39Berrettini, S, Ravecca, F, de Vito, A, Forli, F, Valori, S, Franceschini, SS.Modified Bondy radical mastoidectomy: long-term personal experience. J Laryngol Otol 2004;118:333–7CrossRefGoogle ScholarPubMed
40Kos, MI, Castrillon, R, Montandon, P, Guyot, JP.Anatomic and functional long-term results of canal wall-down mastoidectomy. Ann Otol Rhinol Laryngol 2004;113:872–6CrossRefGoogle ScholarPubMed
41Ramsey, MJ, Merchant, SN, McKenna, MJ.Postauricular periosteal-pericranial flap for mastoid obliteration and canal wall down tympanomastoidectomy. Otol Neurotol 2004;25:873–8CrossRefGoogle ScholarPubMed
42Vartiainen, E.Ten-year results of canal wall down mastoidectomy for acquired cholesteatoma. Auris Nasus Larynx 2000;27:227–9CrossRefGoogle ScholarPubMed
43Castrillon, R, Kos, I, Montandon, P, Guyot, JP.Long-term results of canal wall down mastoidectomy [in French]. Schweiz Med Wochenschr 2000;125:58S–61SGoogle Scholar
44Mills, RP, Padgham, ND.Management of childhood cholesteatoma. J Laryngol Otol 1991;105:343–5CrossRefGoogle ScholarPubMed
45Kronenberg, J, Shapira, Y, Migirov, L.Mastoidectomy reconstruction of the posterior wall and obliteration (MAPRO): preliminary results. Acta Otolaryngol 2012;132:400–3CrossRefGoogle Scholar
46Dornhoffer, JL.Retrograde mastoidectomy. Otolaryngol Clin North Am 2006;39:1115–27CrossRefGoogle ScholarPubMed
47El Sharkawy, A, Mekbel, K, Emam, H, Abdel Razek, M.The use of cartilage and pedicles perichondrial flap for primary reconstruction of posterior canal wall. EJENTAS 2010;10:75–8Google Scholar
48Zhang, ZG, Liu, X, Chen, SJ, Chen, B, Zheng, YQ.Modification of closed tympanoplasty in middle ear cholesteatoma. Chin Med J (Engl) 2010;123:447–51Google ScholarPubMed
49Kang, MK, Ahn, JK, Gu, TW, Han, CS.Epitympanoplasty with mastoid obliteration technique: a long-term study of results. Otolaryngol Head Neck Surg 2009;140:687–91CrossRefGoogle ScholarPubMed
50Abramovich, S, Hannan, SA, Huins, CT, Georgalas, C, McGuinness, J, Vats, A, Thompson, I.Prospective cohort comparison of bioactive glass implants and conchal cartilage in reconstruction of the posterior canal wall during tympanomastoidectomy. Clin Otolaryngol 2008;33:553–9CrossRefGoogle ScholarPubMed
51Uzun, C, Yagiz, R, Tas, A, Adali, MK, Koten, M, Karasalihoglu, AR.Combined Heermann and Tos (CHAT) technique in cholesteatoma surgery: surgical technique and preliminary results. J Laryngol Otol 2005;119:429–35CrossRefGoogle ScholarPubMed
52Ikeda, M, Yoshida, S, Ikui, A, Shigihara, S.Canal wall down tympanoplasty with canal reconstruction for middle-ear cholesteatoma: post-operative hearing, cholesteatoma recurrence, and status of re-aeration of reconstructed middle-ear cavity. J Laryngol Otol 2003;117:249–55CrossRefGoogle ScholarPubMed
53Paparella, MM, Jung, TT.Intact bridge tympanomastoidectomy (I.B.M.) – combining essential features of open vs closed procedures. J Laryngol Otol 1983;97:579–85CrossRefGoogle ScholarPubMed
54Hatano, M, Ito, M, Yoshizaki, T.Retrograde mastoidectomy on demand with soft-wall reconstruction in pediatric cholesteatoma. Acta Otolaryngol 2010;130:1113–18CrossRefGoogle ScholarPubMed
55Haginomori, S, Takamaki, A, Nonaka, R, Takenaka, H.Residual cholesteatoma: incidence and localization in canal wall down tympanoplasty with soft-wall reconstruction. Arch Otolaryngol Head Neck Surg 2008;134:652–7CrossRefGoogle ScholarPubMed
56Della Santina, CC, Lee, SC.Ceravital reconstruction of canal wall down mastoidectomy: long-term results. Arch Otolaryngol Head Neck Surg 2006;132:617–23CrossRefGoogle ScholarPubMed
57Cho, SW, Cho, YB, Cho, HH.Mastoid obliteration with silicone blocks after canal wall down mastoidectomy. Clin Exp Otorhinolaryngol 2012;5:23–7CrossRefGoogle ScholarPubMed
58Lee, WS, Kim, SH, Lee, WS, Kim, SH, Moon, IS, Byeon, HK.Canal wall reconstruction and mastoid obliteration in canal wall down tympanomastoidectomized patients. Acta Otolaryngol 2009 Sep;129:955–61CrossRefGoogle ScholarPubMed
59Takahashi, H, Iwanaga, T, Kaieda, S, Fukuda, T, Kumagami, H, Takasaki, K et al. Mastoid obliteration combined with soft-wall reconstruction of posterior ear canal. Eur Arch Otorhinolaryngol 2007;264:867–71CrossRefGoogle ScholarPubMed
60Leonetti, JP, Marzo, SJ, Beauchamp, MM, Jellish, WS.Long-term results with operated sinus tympani retraction cholesteatoma. Otolaryngol Head Neck Surg 2006;135:152–4CrossRefGoogle ScholarPubMed
61Gantz, BJ, Wilkinson, EP, Hansen, MR.Canal wall reconstruction tympanomastoidectomy with mastoid obliteration. Laryngoscope 2005;115:1734–40CrossRefGoogle ScholarPubMed
62Lee, WS, Choi, JY, Song, MH, Son, EJ, Jung, SH, Kim, SH.Mastoid and epitympanic obliteration in canal wall up mastoidectomy for prevention of retraction pocket. Otol Neurotol 2005;26:1107–11CrossRefGoogle ScholarPubMed
63Dornhoffer, JL.Retrograde mastoidectomy with canal wall reconstruction: a single-stage technique for cholesteatoma removal. Ann Otol Rhinol Laryngol 2000;109:1033–9CrossRefGoogle ScholarPubMed
64Tomlin, J, Chang, D, McCutcheon, B, Harris, J.Surgical technique and recurrence in cholesteatoma: a meta-analysis. Audiol Neurootol 2013;18:135–42CrossRefGoogle ScholarPubMed