Our surgical results on patients with cholesteatoma

Purpose: The purpose of this study is to determine the recidivism rates following the primary surgery on patients with chronic otitis media with cholesteatoma, and to demonstrate, the pathological findings obtained during the operation statistically. Material and Method: The study was carried out by searching the files of the patients who were operated with the suspicion of chronic otitis media with cholesteatoma retrospectively January 2000 and January 2010. Three hundered fourty five patients were included in the study. One hundered fifty one of the patients were female and 194 of them were male. The ages of the patients ranged between 3 and 70 and the average age of the patients was 26. Three different surgical techniques, openl technique, closes technique and radical mastoidectomy, were implemented to all patients. During the operation, the location of cholesteatoma, the condition of ossicle system, whether mastoid obliteration was implemented or not, the condition of facial canal, dehiscence of semicircular canal, whether tegmen defect existed or not and whether tympanoplasty and hearing reconstruction were implemented or not were noted. Postoperative follow-up period was between 12 and 150 months and the average was 36 months. Revision surgery was implemented to 61 patients upon the suspicion of recidivistic disease. During the revision surgery, the region in which cholesteatoma was detected and the condition of ossicle were noted as well The demographic characteristics (age, gender), follow-up periods, recidivism rates of the surgical method which was implemented, the localization of cholesteatoma in the first operation and the localization of cholesteatoma in the revision surgery were compared. Findings: Surgery was implemented to 345 patients for chronic otitis media with cholesteatoma. 27.2% of these patients had close technique mastoidectomy, 23.5% of them had open technique mastoidectomy and 49% of them had radical mastoidectomy. 43.8% of the patients were female and 56.2% of them were male. The localization of cholesteatoma was mastoid cavity in 60.9% of the patients, attic and epimpanium in 59.4% of the patients, in tympanum in 56.2% of the patients, sinus tympanum and facial recess in 12.8% of the patients. The follow up period was 36 months on average. During the follow-up, 17.68% of the patients had revision mastoidectomy operation because of recidivism. Recidivism rates were found to be 62.3% after CWU mastoidectomy, 9.8% after CWD mastoidectomy and 27.9% after radical mastoidectomy. Result: Selecting the surgical method in the patients who will be operated due to cholesteatoma is an important decision to prevent formation of recidivistic disease. The risk of recidivistic disease was observed significantly lower in open surgical technique than close surgical technique. Key Words: Cholesteatoma, Recidivistic disease, Ossicle lysis, Canal Wall Down, Canal Wall Up, Radical mastoidectomy