Cholesteatoma and family history: An international survey

Objective To explore the relative frequency of a family history of cholesteatoma in patients with known cholesteatoma, and whether bilateral disease or earlier diagnosis is more likely in those with a family history. Associations between cleft lip or palate and bilateral disease and age of diagnosis were also explored. Design An online survey of patients with diagnosed cholesteatoma was conducted between October 2017 and April 2019. Participants The sample consisted of patients recruited from two UK clinics and self‐selected respondents recruited internationally via social media. Main outcome measures Side of cholesteatoma, whether respondents had any family history of cholesteatoma, age of diagnosis and personal or family history of cleft lip or palate were recorded. Results Of 857 respondents, 89 (10.4%) reported a positive family history of cholesteatoma. Respondents with a family history of cholesteatoma were more likely to have bilateral cholesteatoma (P = .001, odds ratio (OR) 2.15, 95% confidence interval (CI) 1.35‐3.43), but there was no difference in the age of diagnosis (P = .23). Those with a history of cleft lip or palate were not more likely to have bilateral disease (P = .051, OR 2.71, CI 1.00‐7.38), and there was no difference in age of diagnosis (P = .11). Conclusion The relatively high proportion of respondents that reported a family history of cholesteatoma offers supporting evidence of heritability in cholesteatoma. The use of social media to recruit respondents to this survey means that the results cannot be generalised to other populations with cholesteatoma. Further population‐based research is suggested to determine the heritability of cholesteatoma

Giant petrous bone cholesteatoma: combined microscopic surgery and an adjuvant endoscopic approach

Petrous bone cholesteatomas (PBCs) are epidermoid cysts, which have developed in the petrous portion of the temporal bone and may be congenital or acquired. Cholesteatomas arising in this region have a tendency to invade bone and functional structures and the middle and posterior fossae reaching an extensive size. Traditionally, surgery of a giant PBC contemplates lateral transtemporal or middle fossa microscopic surgery; however, in recent years, endoscopic surgical techniques (primary or complementary endoscopic approach) are starting to receive a greater consensus for middle ear and mastoid surgeries. We report the rare case of an 83-year-old Caucasian male affected by a giant cholesteatoma that eroded the labyrinth and the posterior fossa dura and extended to the infralabyrinthine region, going beyond the theca and reaching the first cervical vertebra. The giant cholesteatoma was managed through a combined approach (microscopic and, subsequently, complementary endoscopic approach). In this case report, we illustrate some advantages of this surgical choice

False-Positive Cholesteatomas on Non-Echoplanar Diffusion-Weighted Magnetic Resonance Imaging.

ObjectivesTo investigate false-positive findings on non-echoplanar (non-EPI) diffusion-weighted magnetic resonance imaging (DWI) in patients under surveillance post-cholesteatoma surgery.Study design, setting, subjects, and methodsA retrospective review was performed on patients diagnosed with cholesteatoma who underwent surgical resection and were then followed by serial non-EPI DWI using half-Fourier acquisition single-shot turbo spin echo (HASTE) sequence. All patients had at least two annual follow-up imaging studies.ResultsFalse-positive findings were identified in four patients. The size of the suspected lesions was 4 to 12 mm. Otoendoscopy was used during all primary cases and Argon laser was used in one case. In all cases, the entire cholesteatoma was removed, and no residual disease was detected at the end of the procedures. One patient underwent revision surgery but only cartilage graft was found in the area of concern. All patients had stable or resolved hyperintense areas in the subsequent HASTE sequences.ConclusionFalse positive findings can occur with non-EPI DWI MRI and patients need to be counseled accordingly before revision surgery. Decreasing intensity and dimension of a suspected lesion and a positive finding in an area other than the location of the initial cholesteatoma may favor a false positive. If a false positive finding is suspected when the surgeon is confident of complete resection of the cholesteatoma, an MRI can be repeated in 6 to 12 months to assess changes in the dimension and intensity of the area of concern. Cartilage grafts may cause restricted diffusion on DWI sequences

ENDOSCOPIC TYPMPANOMASTOID EXPLORATION [FUNCTIONAL ENDOSCOPIC EAR SURGERY-FEES]

Tympano mastoidectomy is usually performed using operating microscope. This study reports a case series of tympanomastoidectomy which was performed using an endoscope.Endoscopic Tympanomastoidectomy for atticoantral type of CSOM is an excellent technique for complete removal of cholesteatoma especially from inaccessible areas of middle ear cleft including facial recess, sinustympani Transmeatal removal of disease from mastoid antrum and even tip cells is possible withendoscopes. Preservation of as much of normal mucosa of the middle ear cleft is possible with thistechnique, which promotes early reaeration of the mastoid cavity leading to better hearing outcome.Soft wall reconstruction has distinctive advantage of short additional time for reconstruction procedures, restoration of self cleaning EAC, early post operative epithelisation of tympanicmembrane and the EAC. Limitation of endoscopic technique: The endoscopic technique of tympanomastoidectomy with softwall reconstruction is not possible in cases with large mastoid cavity and in ears where a thin lateral rim of bony meatal wall (that can support soft wall) is retained, because of extensive disease.Like Functional Endoscopic sinus surgery (FESS) for nose, Endoscopes have changed thetreatment concept of atticoantral disease, with complete removal of the disease andpreservation of normal mucosa, that restores the normal physiology of middle ear cleft. Thishas led to the development of new concept of Functional Endoscopic Ear Surgery (FEES) foratticoantral type of CSOM.

Day-case management of chronic suppurative otitis media with cholesteatoma with canal wall down technique surgery: long-term follow-up

The overall number of day-case otologic surgery cases is increasing; however, there is limited experience about performing canal wall down tympanoplasty in patients with chronic suppurative otitis media with cholesteatoma in this setting. The objective of this study was to assess the success of this technique as day-case surgery in terms of results and complications over an 8-year follow up period. We included in this study 42 patients undergoing canal wall down technique tympanoplasty surgery for chronic suppurative otitis media with cholesteatoma performed as day cases during a 2-year period. 30 cases (71.4%) were discharged on the day of surgery, whereas 12 cases (28.6%) were hospitalized and discharged the day after. The principal reasons for failure of discharge on the day of surgery were asthenia (6 cases), vertigo and asthenia (4 cases), undetermined (2 cases). Based on our experience, with a proper preoperative selection, assessment and screening of the patients, mastoidectomy with timpanoplasty for chronic suppurative otitis media with cholesteatoma can be carried out in a day surgery setting with no significant effects on effectiveness of surgery, post-operative symptoms and relapse of disease even in the long term

Endaural tympanoplasty without flap : a report on 34 cases

The most carefully planned and executed operation on the ear is a failure as far as the patient is concerned if the cavity collects debris and discharges for months and years afterwards. According to Mawson (1967), twenty-five per cent of radical mastoid cavities fail to heal, remain infected and discharge persistently after operation. Of 428 tympanoplasties done by Portmann (1963) between 1959 and 1962, only 75 per cent achieved perfectly dry cavities.peer-reviewe

Transitions in auditory rehabilitation with bone conductive implant (bci)

Background: The bone conductive implants (BCI) are nowadays a reliable alternative for rehabilitation of specific forms of hearing loss, i.e. conductive, mixed or single sided deafness (SSD). Aims/Objective: To analyse the various factors in play when considering an auditory rehabilitation with a bone-conductive device (BCI). Materials and Methods: The clinical charts of subjects who underwent BCI application at the same Implanting Center from 2005 to 2018 were retrieved analysing also the reason for eventual explantation and the alternative option (transition) for hearing rehabilitation. Results: Nine BAHA Compact, 4 BAHA Intenso, 21 BAHA Divino, 3 BAHA BP100, 4 Ponto, 2 Sophono, 5 Bonebridge, 5 BAHA5 Attract; 11 BAHA5 Connect were used in 12 unilateral COM; 16 bilateral COM; 3 unilateral cholesteatoma; 6 bilateral cholesteatoma; 2 unilateral otosclerosis; 5 bilateral otosclerosis; 9 congenital malformations; 6 major otoneurosurgical procedures; 5 sudden deafness. Explantation was necessary for five subjects. Conclusions: Middle ear pathology and sequels from surgery represent the most common reason for BCI implantation, both in unilateral and in bilateral cases. Transition from one implantable device to another one can be predictable, mostly when explantation is necessary. Significance: The role of BCI for rehabilitation in middle ear pathology may be extremely important

An unusual complication of otitis media: Luc's abscess

Luc’s abscess is an extremely rare complication of otitis media, caused by the spread of the middle ear infection to the subperiosteal area and its accumulation beneath the temporal muscle. Unlike other subperiosteal abscesses relating to otitis media, infection may not be associated with mastoid bone involvement. Therefore, it is defined as a benign complication of otitis media. However, its rare occurrence may lead to delayed diagnosis and treatment. Here we report a case of an 11-year-old boy diagnosed with Luc’s abscess with mastoid involvement. We discuss its clinical presentation and treatment with a review of the literature. © 2018 by The European Academy of Otology and Neurotology and The Politzer Society

Medially-invasive cholesteatoma

Cholesteatoma is life-threatening disease due to its intracranial complications. Some of cholesteatoma cases we define as aggressive cholesteatoma. In this category we include children cholesteatoma, medially-invasive cholesteatoma and petrous apex cholesteatoma which does not originate in the petrous apex. Another special form of cholesteatoma is petrous bone cholesteatoma. Retrospective study of 176 cholesteatoma operations (38.85%) from 453 consecutive middle ear surgeries for 4 years and 4 months in Trakia Park Hospital Stara Zagora, Bulgaria were rewieved. The same surgeon performs 106 Primary Cholesteatoma Surgery, 49 Revision Surgery and 21 Second-Look Surgery. In this 176 cholesteatoma cases the cholesteatoma matrix involve the otic capsule, petrous apex or skull base in 5 patients, who are defined as medially-invasive cholesteatoma (2.84%). In this medially-invasive cholesteatoma patients surgical resection with canal wall down operation remains the best treatment option