OPEN TECHNIQUE – INDICATIONS AND RESULTS

Yasuomi Kunimoto,1,2 Giulio Sequino,1 Abdelkader Taibah,1 Mario Sanna1 1Gruppo Otologico, Piacenza, Italy; 2Tottori University, Yonago, Japan

Introduction

The surgical treatment goals for cholesteatoma are complete disease eradication, achievement of a dry and self-cleaning ear, creation of anatomic conditions that prevent recurrence, preservation of hearing, and avoidance of routine revision surgery.13 There are two basic surgical approaches to treating cholesteatoma: open technique and closed technique. When marked attic erosion is present in cholesteatoma, especially in adults, we perform the open technique to avoid cholesteatoma recurrence. Other major indications of open technique in our institution are: cholesteatoma in cases of only hearing ear, advanced age, poor general condition, extensive canal-wall erosion, recurrence after the canal-wall-up tympanoplasty, profound sensory neural hearing loss, contracted mastoid, large labyrinthine fistula, and far anterior sigmoid sinus or low dura.4 Extensive pneumatization of the temporal bone is the contra-indication. To avoid post-operative complications in the open technique, it is very important to create an ideal cavity in the first surgery by following correct procedures such as sufficient saucerization of the cavity and appropriate meatoplasty.

Methods

Seven hundred and ninety-nine patients were operated by open technique at the Gruppo Otologico from 1994 to 2005. Pre-operative symptoms, surgical complications, and hearing results were evaluated.

Results

Major pre-operative symptoms were hearing loss (67.2%), otorrhea (60.5%), tinnitus (18.7%), and vertigo (14.0%). There were no post-operative symptoms in 82.9%. Recurrent otorrhea (10.0%), perforation (3.0%), atelectasis (1.7%), recurrent cholesteatoma (1.3%), and stenosis of external auditory canal (1.1%) were detected and other complications were seen in less than 1%. Complications of otorrhea, infection, and vertigo were temporary. On almost half of all patients staged operation was performed, and 3.2% of the patients had residual cholesteatoma at second surgery. Out of 799, 528 patients were followed up more than one year at our institution, and underwent post-operative audiometry. The mean follow up was 60.5 months (range, 12 to 182 months). The pre-operative ABG was within 20 dB in 15.5% cases, but improved to 45.2% post-operatively (Fig. 1).

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Fig. 1. Hearing result. Pre-operative ABG was within 20 dB in 15.5% cases, but improved to 45.2% post-operatively.

Table 1. Postoperative complications in 539 patients.

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Conclusion

Open technique is an appropriate treatment for acquired cholesteatoma. When performed well, the rate of recurrent cholesteatoma is very low. But poorly performed open technique leads to failures and complications.

References

1.Quaranta A, Cassano P, Carbonara G. Cholesteatoma surgery: open vs closed tympanoplasty. Am J Otol 9:229–231, 1988

2.Sanna M, Zini C, Scandellari R, Jemmi G. Residual and recurrent cholesteatoma in closed tympanoplasty. Am J Otol 5:277–282, 1984

3.Sanna M, Zini C, Gamoletti R, Taibah AK, Russo A, Scandellari R. Closed versus open technique in the management of labyrinthine fistulae. Am J Otol 9:470–475, 1988

4.Sanna M, Shea CM, Gamoletti R, Russo A. Surgery of the ‘only hearing ear’ with chronic ear disease. J Laryngol Otol 106:793–798, 1992


Address for correspondence: Yasuomi Kunimoto, Nishimachi 86, Yonago, Tottori, 6838503, Japan. kunimon0608@yahoo.co.jp

Cholesteatoma and Ear Surgery – An Update, pp. 223–224

Edited by Haruo Takahashi

2013 © Kugler Publications, Amsterdam, The Netherlands