Clinical and Surgical Features of Acquired Middle Ear Cholesteatoma: A 10 Years Population-based Study

Cholesteatomas are benign destructive lesions of the temporal bone that may lead to life-threatening complications.

This study described the clinical and surgical characteristics of chronic otitis media patients with acquired middle ear cholesteatoma.

Among 1790 patients with chronic otitis media detected during almost 10 years, 449 suffered from cholesteatoma. The clinical features and surgical data were investigated.

Among the chronic otitis media patients, 449 (25.0%) cases had cholesteatoma with a mean age of 32.2 ± 16.1 SD years, and 62.8% were male. The most common symptom was otorrhoea (53%), followed by hearing impairment (37.9%). Erosion of the facial nerve canal was observed in 33.1% of patients, dural plate erosion in 4.8% of cases, and labyrinthine fistula in 10.3% of patients. Moreover, ossicular chain erosion was observed with the highest frequency in incus (40%), followed by malleus (33%) and stapes (26%). Amongst the surgically treated patients, 59.3% underwent mastoidectomy with canal wall preservation, 29.7% underwent modified radical mastoidectomy, and radical mastoidectomy was performed in 11% of patients.

Cholesteatoma was seen in about a quarter of patients with chronic otitis media. Based on our findings, cholesteatoma can be associated with serious complications such as facial nerve canal erosion (33.1%), dural plate erosion (4.8%), and labyrinthine fistula (10.3%). Regarding the functional importance of the hearing system and the high prevalence of disease complications, middle ear cholesteatoma needs long-term follow-up.