Surgery for Pediatric Cholesteatoma Follow-up
- Author: Peter S Roland, MD; Chief Editor: Glenn C Isaacson, MD, FACS, FAAP more...
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.
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.
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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