About this Research Topic
Surgery is the mainstay of treatment in chronic otitis media with cholesteatoma, however, consensus on the best surgical approach and technique still forms part of the debate in the international literature. The primary goal of surgical treatment is total excision of the disease without recurrence. Canal wall-up (CWU) tympanoplasty is compared to canal wall-down (CWD) surgery in a recent systematic review, with generally lower recidivism rates for the CWD approach (CWU: 17-61%; CWD: 0-13%).
However, due to well-known postoperative constraints related to the CWD technique (i.e., frequent cleaning outpatient clinic, poorer hearing, restriction to water exposure), the CWU technique is preferable. Interestingly, the canal wall-up (CWU) technique with mastoid obliteration might deliver lower residual disease rates compared to the canal wall-up tympanoplasty without mastoid obliteration. More and more recent literature is available providing lower recurrent cholesteatoma rates in the former group comparable to those after the CWD technique, even in the long term (follow-up>5 years). However, most of these publications are performed by experienced surgeons in large tertiary referral centers in a retrospective observational manner. Methodologically, there might still be some confounding factors interfering with the conclusions drawn from these studies (i.e. experience of the surgical team, extensiveness of the cholesteatoma, involvement of other structures in the disease (i.e. facial nerve, ossicular chain, tegmen, labyrinth).
Regarding postoperative follow-up, beforehand patients underwent second-look operations 9 to 12 months after the surgery. Quite often, this procedure was combined with an ossicular chain reconstruction to restore hearing in an unaffected or non-inflamed ear. However, in 2007 a new promising imaging technique came up (MRI Diffusion Weighted Imaging, DWI) which deviated from the need for a second look surgery, with its high sensitivity and specificity. Cholesteatoma resection surgery and ossicular chain reconstruction could from then on be done single stage.
To bring forward the latest insights for optimal treatment and follow-up of cholesteatoma pathology. Study groups focusing on epidemiological, clinical, radiological, or anatomical investigations are invited to submit their work.
However, due to well-known postoperative constraints related to the CWD technique (i.e., frequent cleaning outpatient clinic, poorer hearing, restriction to water exposure), the CWU technique is preferable. Interestingly, the canal wall-up (CWU) technique with mastoid obliteration might deliver lower residual disease rates compared to the canal wall-up tympanoplasty without mastoid obliteration. More and more recent literature is available providing lower recurrent cholesteatoma rates in the former group comparable to those after the CWD technique, even in the long term (follow-up>5 years). However, most of these publications are performed by experienced surgeons in large tertiary referral centers in a retrospective observational manner. Methodologically, there might still be some confounding factors interfering with the conclusions drawn from these studies (i.e. experience of the surgical team, extensiveness of the cholesteatoma, involvement of other structures in the disease (i.e. facial nerve, ossicular chain, tegmen, labyrinth).
Regarding postoperative follow-up, beforehand patients underwent second-look operations 9 to 12 months after the surgery. Quite often, this procedure was combined with an ossicular chain reconstruction to restore hearing in an unaffected or non-inflamed ear. However, in 2007 a new promising imaging technique came up (MRI Diffusion Weighted Imaging, DWI) which deviated from the need for a second look surgery, with its high sensitivity and specificity. Cholesteatoma resection surgery and ossicular chain reconstruction could from then on be done single stage.
To bring forward the latest insights for optimal treatment and follow-up of cholesteatoma pathology. Study groups focusing on epidemiological, clinical, radiological, or anatomical investigations are invited to submit their work.
Keywords: Cholesteatoma Surgery, CWU, CWD, Cholesteatoma Pathology, Mastoid Obliteration, Postoperative Care, Surgical Approaches
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