Surgery for Pediatric Cholesteatoma Follow-up

  • Author: Peter S Roland, MD; Chief Editor: Glenn C Isaacson, MD, FACS, FAAP   more...
 
Updated: Mar 25, 2010
 

Further Outpatient Care

  • Observe each patient with cholesteatoma for many years.
    • Recurrence can occur long after the initial surgical excision.
    • Include semiannual or annual evaluations in follow-up care, even in the otherwise asymptomatic patient.
  • Patients who have undergone open cavity procedures may require follow-up care as often as every 3 months for canal cleaning. In contrast, some patients require cleaning only once per year. How frequently these patients require cleaning to keep the canal free of desquamated epithelium and cerumen soon becomes apparent.
  • Patients who have had closed cavity operations generally require a second look procedure 6-9 months after the original operation.
  • Once the second look incisions are healed, regular follow-up care at 6- to 12-month intervals is necessary to ensure against persistence or recurrence of cholesteatoma.
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Complications

  • Various complications are possible from cholesteatoma and cholesteatoma surgery. The most feared complication is facial nerve paralysis. The incidence of permanent facial nerve injury following cholesteatoma surgery is not entirely certain but appears to be approximately 1% or less. Whether facial nerve monitoring helps reduce the risk of postoperative facial nerve injury is controversial.
  • A 1-2% chance of total neurosensory hearing loss is associated with cholesteatoma removal. A cholesteatoma that has produced a labyrinthine fistula or that lies directly over the footplate is more likely to produce permanent neurosensory loss.[9]
  • Many patients have alteration of taste on the anterior ipsilateral tongue for weeks after an otologic procedure. However, this condition usually resolves within a few months after surgery.
  • Long-term balance disturbance can occur because of labyrinthine or middle ear injury but is uncommon (occurring in < 1% of patients).
  • In approximately 10-15% of patients, the graft fails, and a permanent TM perforation follows tympanomastoidectomy for removal of cholesteatoma. Such perforations frequently can be eliminated by surgical treatment.
  • Depending on the procedure, approximately 5-30% of operations are unsuccessful, and cholesteatoma persistence or recurrence manifests at some point in the postoperative period. Persistence may appear as early as 5-6 months postoperatively or may be delayed for many years. Consequently, close follow-up care is important.
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Prognosis

  • Elimination of cholesteatoma is almost always possible. However, multiple operations may be required. Because surgery is generally successful, complications from an uncontrolled cholesteatoma are now relatively uncommon.
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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

Specialty Editor Board

Orval Brown, MD  Director of Otolaryngology Clinic, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center at Dallas

Orval Brown, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Bronchoesophagological Association, American College of Surgeons, American Medical Association, American Society of Pediatric Otolaryngology, Society for Ear, Nose and Throat Advances in Children, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

John E McClay, MD  Associate Professor of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Dallas, University of Texas Southwestern Medical School

John E McClay, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Medical Association

Disclosure: Nothing to disclose.

Paul D Petry, DO, FACOP, FAAP  Consulting Staff, Freeman Pediatric Care, Freeman Health System

Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Glenn C Isaacson, MD, FACS, FAAP  Professor of Otolaryngology-Head and Neck Surgery and Pediatrics, Temple University School of Medicine

Glenn C Isaacson, MD, FACS, FAAP is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Society of Pediatric Otolaryngology, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Covidien Honoraria Consulting

References

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  19. Tierney PA, Pracy P, Blaney SP, Bowdler DA. An assessment of the value of the preoperative computed tomography scans prior to otoendoscopic 'second look' in intact canal wall mastoid surgery. Clin Otolaryngol Allied Sci. Aug 1999;24(4):274-6. [Medline].

 
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A typical audiogram demonstrating bilateral conductive hearing loss, which may be observed in an individual with a cholesteatoma.
The photo exhibits a large meatoplasty performed as part of an open cavity (canal wall down) mastoidectomy. A similar meatoplasty usually is necessary if a clean, dry, problem-free cavity is to be maintained.
An unenhanced CT scan demonstrating that the posterior canal wall has been eroded and the external auditory canal has filled with cholesteatoma, pus, and debris. Surprisingly, the middle ear appears relatively free of disease, a characteristic of primary acquired cholesteatomas.
 
 
 
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