Surgical management of middle ear cholesteatoma and reconstruction at the same time.
BACKGROUND
In the surgical management of cholesteatoma, one can opt for a closed technique (simple mastoidectomy) or open surgery (radical mastoidectomy). Open mastoidectomy with reconstruction of the posterior wall and the middle ear in a single surgery combines the advantages of both techniques, namely, adequate surgical exposure, eradication of cholesteatoma, and anatomical reconstruction of the middle ear structures.


OBJECTIVE
To evaluate the surgical results in the management of cholesteatoma through the technique of open mastoidectomy with reconstruction of the posterior wall and the middle ear in a single surgery.


METHODS
Prospective analytical observational study conducted between 2009 and 2012 with patients undergoing this surgical technique in the Hospital Universitario del Valle [University Hospital of Valle], performing preoperative clinical monitoring and quarterly postoperative tomography with previous assessments of hearing and pre- and postoperative audiometry.


RESULTS
Forty-five patients were studied. Mean postoperative follow-up was 28 months. Surgical success was achieved in 93.3% of patients, as measured by clinical and radiological follow-up. Hearing preservation was found after reconstruction of the hearing mechanism, based on measured audiometry, i.e., pure-tone average (PTA), using the statistical test for paired samples between preoperative and postoperative PTA. (95%CI -1.47-12.15). Residual cholesteatoma was present in 6.6% of cases; three to four times lower than the rate reported in the literature.


CONCLUSIONS
This type of surgery can be considered a successful technique in the treatment of cholesteatoma in selected cases.
Professor. Specialization in Otology and Neuro-Otology, University of Valle. Cali, Colombia.
Pedro
P
Blanco
Otology and Neuro-Otology, University of Valle. Cali, Colombia.
Francisco
F
González
Otology and Neuro-Otology, University of Valle. Cali, Colombia.
Jorge
J
Holguín
Otology and Neuro-Otology, University of Valle. Cali, Colombia.
Claudia
C
Guerra
D000328:Adult; D001299:Audiometry; D018424:Cholesteatoma, Middle Ear / Q000601:surgery*; D003105:Colombia; D005260:Female; D005500:Follow-Up Studies; D006309:Hearing; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome
COG; Cholesteatoma; canal-wall-down mastoidectomy (CWD); canal-wall-up mastoidectomy (CWU); ossiculoplasty; reconstruction mastoidectomy