Management of invasive intralabyrinthine cholesteatoma: Can one realistically preserve hearing when disease is medial to the otic capsule?

To report our long-term results in surgical management of invasive intralabyrinthine cholesteatoma. The study is a case series in a tertiary referral center. Retrospective chart review of all mastoid operations performed for chronic ear disease between 1994 and 2019 at University Health Network, Tor...

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Published inAmerican journal of otolaryngology Vol. 41; no. 3; p. 102407
Main Authors Al Zaabi, Khalid, Hassannia, Fatemeh, Bergin, Michael J., Rutka, John Alexander
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.05.2020
Elsevier Limited
Subjects
Abscesses
Bone surgery
Carotid arteries
Cholesteatoma
Cochlea
Complications
Ear
Ear canal
Fistula
Hearing
Hearing loss
Mastoidectomy
Paralysis
Patients
Petrosectomy
Petrous bone
Surgery
Surgical outcomes
Vestibular system
Petrous bone
Cholesteatoma
Petrosectomy
Mastoidectomy
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Summary:To report our long-term results in surgical management of invasive intralabyrinthine cholesteatoma. The study is a case series in a tertiary referral center. Retrospective chart review of all mastoid operations performed for chronic ear disease between 1994 and 2019 at University Health Network, Toronto. The type of surgery, intraoperative findings, hearing outcome, recurrence of disease and the need for revision surgery were evaluated. 10 cases of extensive petrous bone cholesteatoma medial to the otic capsule were identified in 616 mastoid surgeries. All but one patient with extensive petrous bone cholesteatoma who underwent an exteriorizing procedure to preserve cochlear function failed the first surgery. A second procedure was needed in all cases due to complications which included facial palsy, recurrent cholesteatoma or internal auditory canal (IAC) abscess. Hearing was not preserved in any patient. In contrast, 57 ears with cholesteatomatous labyrinthine fistula lateral to the otic capsule had matrix exteriorized and had very good long-term results. We were rarely able to preserve hearing in massive petrous bone cholesteatoma. There should be no hesitation to remove the otic capsule to exteriorize diseases even under circumstances where residual cochlear and vestibular function is present if required to provide a safe ear.
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ISSN:0196-0709
1532-818X
DOI:10.1016/j.amjoto.2020.102407