[One-stage surgery of middle ear cholesteatoma in adults: apropos of 180 cases].
OBJECTIVE
In order to evaluate the results of tympanoplasty in one stage middle ear cholesteatoma surgery, a retrospective study of 180 consecutive cholesteatomas operated on was undertaken.


METHODS
150 single procedures and 30 revision surgeries realized between 1992 and 1997 were analysed by studying anatomical and functional results with a mean follow-up of 24 months.


RESULTS
Among the 150 adult patients, 85 (57%) were previously operated on in other centres and presented a recurrence of cholesteatoma. Closed technique was performed in 110 cases (61%) and opened one in the remaining cases (41%). Ossiculoplasty was made in 101 cases (56%) with different materials (15 incus autografts, 14 teflon prosthesis, 35 hydroxyapatite (HA) composite prosthesis and 37 all in HA prosthesis): 91 cases in a one-stage procedure but 10 worse functional results required a closed revision procedure. Twenty cases were also revised after one year of follow up at least: six recurrences of cholesteatoma were operated on by using canal down mastoidectomy (4%), 14 limited residual cholesteatomas (9.3%) had a revision closed technique procedure. CT Scan followed up all the patients operated on by a closed technique. Postoperative air-bone gap (ABG) was 20 +/- 11.3 dB and 27 +/- 10.1 dB in closed and opened techniques, respectively (p < 0.05). ABG was 20 +/- 9.2 dB and 26 +/- 13 dB in type II and type III tympanoplasty, respectively (p < 0.05).


CONCLUSIONS
If the tympanic and posterior cavities are reasonably safe, middle ear cholesteatoma in adults can be well cured by a one-stage procedure including ossicular chain reconstruction with hydroxylapatite prosthesis covered with cartilage graft who achieved a valuable hearing restoration.
Rondini-Gilli
E
E
Hôpital Beaujon, AP-HP, Faculté Xavier Bichat, Université Paris 7, 92110 Clichy, France.
Mosnier
I
I
Julien
N
N
Gouin
J M
JM
Aïdan
P
P
Rufat
P
P
Sterkers
O
O
D000328:Adult; D001672:Biocompatible Materials; D018424:Cholesteatoma, Middle Ear / Q000601:surgery*; D017886:Durapatite; D005260:Female; D005500:Follow-Up Studies; D006309:Hearing; D006801:Humans; D007188:Incus / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D009998:Ossicular Prosthesis; D011138:Polytetrafluoroethylene; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014433:Tympanoplasty
D001672:Biocompatible Materials; D011138:Polytetrafluoroethylene; D017886:Durapatite