Hearing outcome after sequential cholesteatoma surgery.
The objective of this study was to assess hearing outcome after sequential cholesteatoma surgery stratified for exclusively transcanal technique (ETC), combined transcanal and transmastoidal technique (TCM) and canal wall down surgery (CWD) and to analyze the impact of ossicular reconstruction technique (partial ossicular replacement prostheses/PORP and total ossicular replacement prostheses/TORP) on hearing outcome. This study is a retrospective case review and clinical case study conducted in a tertiary referral center. Patients who underwent 376 cholesteatoma surgeries (2007-2009) and 92 ears in clinical re-examination at least 12 months postoperatively were included. Sequential cholesteatoma surgery with ETC, TCM, or CWD; ossiculoplasty with PORP or TORP were the interventions administered. Pre- and postoperative air-bone gap (ABG) and air conduction threshold (AC) for 0.5-3 kHz were the main outcome measures. Overall, the mean preoperative ABG decreased from 25.3 ± 1.3 to 19.8 ± 0.9 dB with a mean ABG closure of 5.4 ± 1.3 dB (p ≤ 0.001). According to surgical technique, the postoperative ABG after CWD 23.5 ± 2.1 was significantly worse compared to ETC (17.3 ± 1.0 dB, p < 0.05) and TCM (19.4 ± 1.3 dB). A significant ABG closure was observed after ETC (6.8 ± 2.0 dB, p < 0.01) and TCM (6.5 ± 2.0 dB, p < 0.01) contrary to CWD (2.1 ± 2.9 dB, p > 0.05). Patients receiving PORP showed a significantly less ABG postoperatively (19.0 ± 0.9 dB, p ≤ 0.05) compared to the TORP group (24.1 ± 2.5 dB). However, a significant hearing gain was assessed after PORP- (4.7 ± 1.6 dB, p ≤ 0.01) and TORP- implantation (10.4 ± 3.7 dB, p ≤ 0.01). Sequential cholesteatoma surgery allowed for an excellent hearing outcome postoperatively. An intact posterior canal wall and a present stapes suprastructure were identified to predict a significantly superior hearing result. In addition to the technical and prosthetic considerations, the audiological outcome was confounded by the attending middle ear pathology.
Department of Otorhinolaryngology, Head and Neck surgery, Technische Universität Dresden, Medizinische Fakultät Carl Gustav Carus, Fetscher Strasse 74, 01307, Dresden, Saxony, Germany. susen.lailach@uniklinikum-dresden.de.
Susen
S
Lailach
Department of Otorhinolaryngology, Head and Neck surgery, Technische Universität Dresden, Medizinische Fakultät Carl Gustav Carus, Fetscher Strasse 74, 01307, Dresden, Saxony, Germany.
Thomas
T
Zahnert
Department of Otorhinolaryngology, Head and Neck surgery, Technische Universität Dresden, Medizinische Fakultät Carl Gustav Carus, Fetscher Strasse 74, 01307, Dresden, Saxony, Germany.
Nikoloz
N
Lasurashvili
Department of Otorhinolaryngology, Head and Neck surgery, Technische Universität Dresden, Medizinische Fakultät Carl Gustav Carus, Fetscher Strasse 74, 01307, Dresden, Saxony, Germany.
Max
M
Kemper
Department of Otorhinolaryngology, Head and Neck surgery, Technische Universität Dresden, Medizinische Fakultät Carl Gustav Carus, Fetscher Strasse 74, 01307, Dresden, Saxony, Germany.
Thomas
T
Beleites
Department of Otorhinolaryngology, Head and Neck surgery, Technische Universität Dresden, Medizinische Fakultät Carl Gustav Carus, Fetscher Strasse 74, 01307, Dresden, Saxony, Germany.
Marcus
M
Neudert
D000328:Adult; D000368:Aged; D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis / Q000601:surgery*; D057186:Comparative Effectiveness Research; D005260:Female; D006320:Hearing Tests / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009998:Ossicular Prosthesis; D019933:Ossicular Replacement / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D011184:Postoperative Period; D012189:Retrospective Studies; D013199:Stapes; D016896:Treatment Outcome; D014433:Tympanoplasty / Q000009:adverse effects / Q000379:methods
Canal wall down; Canal wall up; Cholesteatoma; Hearing outcome; Intact canal wall; Ossiculoplasty; Partial ossicular reconstruction prostheses; Total ossicular reconstruction prostheses; Tympanoplasty