eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Middle Ear & Mastoid

Middle Ear, Cholesteatoma: Follow-up

Author: Peter S Roland, MD, Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director of Clinical Center for Auditory, Vestibular and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Adjunct Professor of Communicative Disorders, University of Texas School of Human Development
Contributor Information and Disclosures

Updated: Jun 29, 2009

Outcome and Prognosis

Eliminating a cholesteatoma is almost always possible; however, multiple operations may be required. Because surgery is generally successful, complications from uncontrolled cholesteatoma growth are now relatively uncommon.

Canal-wall-down tympanomastoidectomy offers a very low rate of recurrence or persistence of a cholesteatoma. Reoperation for cholesteatomas occurs in 5% or fewer patients. This compares quite favorably to the 20-40% recurrence rates associated with closed-cavity techniques11 .

Nonetheless, because the ossicular chain and/or tympanic membrane cannot always be completely restored to normal, cholesteatomas remain a relatively common cause of permanent conductive hearing loss.

Future and Controversies

Controversies

The routine use of facial nerve monitoring remains controversial. A survey of practicing otologists in 1990 showed that most experienced otologists do not believe that facial nerve monitoring is obligatory. Many experienced otologists only use it occasionally. Facial nerve monitoring requires experience and is unlikely to provide meaningful protection to an inexperienced surgeon.

On the other hand, some surgeons believe that predicting the cases in which the facial nerve is at risk is impossible and, consequently, believe monitoring should be performed in every case. These surgeons see facial nerve monitoring as a precaution, much like ECG monitoring, that may be potentially useful in any given case.

A large percentage of surgeons do not use facial nerve monitoring for all cases but, instead, monitor only selected cases. Such cases often include revision operations or situations in which the patient has had perioperative facial nerve weakness in the past or when imaging studies show facial nerve anomalies.

Future

The applicability of using small otoendoscopes as part of the surgical management of cholesteatomas is being explored. To date, they have only an adjunctive role; however, their role may expand in the future.

 
Acknowledgments

The author is grateful for the expert help of Pam Henderson in the preparation of this manuscript.



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References
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References

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Further Reading

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Keywords

keratoma, cholesteatoma, middle ear cholesteatoma, canal-wall-down otologic surgery, canal-wall-up otologic surgery, canal-wall-down technique, canal-wall-up technique, ear lesion, ear mass, congenitally acquired cholesteatoma, primarily acquired cholesteatoma, secondarily acquired cholesteatoma, congenital cholesteatoma, primary cholesteatoma, secondary cholesteatoma, chronic middle ear fluid, conductive hearing loss, tympanic membrane retraction, tympanic membrane trauma, tympanic membrane injury, acute otitis media, AOM, OM, acute OM, tympanic membrane perforation, painless otorrhea, otorrhea, hearing loss, deafness

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Contributor Information and Disclosures

Author

Peter S Roland, MD, Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director of Clinical Center for Auditory, Vestibular and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Adjunct Professor of Communicative Disorders, University of Texas School of Human Development
Peter S Roland, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American Laryngological Rhinological and Otological Society, American Neurotology Society, American Otological Society, North American Skull Base Society, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Alcon labs Honoraria Speaking and teaching; GSK Honoraria Speaking and teaching; Advanced Bionics Honoraria Board membership; Cochlear corp Honoraria Board membership; Med El corp travel grants Consulting

Medical Editor

Jack A Shohet, MD, Associate Clinical Professor, Department of Otolaryngology-Head and Neck Surgery, University of California Irvine; Otolaryngologist, Shohet Ear Associates Medical Group, Inc
Jack A Shohet, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Neurotology Society, American Tinnitus Association, and California Medical Association
Disclosure: Envoy Medical Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gerard J Gianoli, MD, Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine; Vice President, The Ear and Balance Institute; Chief Executive Officer, Ponchartrain Surgery Center
Gerard J Gianoli, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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