Page 57 - Revista Portuguesa - SPORL - Vol 63. Nº2

Surgery for Chronic otitis media with

cholesteatoma: 10-year review

Artigo Original

Autores Resumo

Introduction: Optimal surgical management
Simão Bessa for Chronic otitis media with cholesteatoma
Unidade Local de Saúde do Tâmega e Sousa, is controversial. Decisions regarding surgical
Portugal approaches are still highly debated today.
Analysing and comparing our experience may help
Noémi Nogueira us to expand our common knowledge and predict
Unidade Local de Saúde do Tâmega e Sousa, further outcomes facilitating the discussion and
Portugal
choice of treatment options.
Débora Gonçalves Objectives and methodology: The authors
Unidade Local de Saúde do Tâmega e Sousa, conducted a retrospective review of medical
Portugal records regarding patients who underwent surgery
for cholesteatoma from January 2012 to December
Liliana Costa 2022. Analysis was made regarding preoperative
Unidade Local de Saúde do Tâmega e Sousa, parameters, surgical approaches, hearing results,
Portugal surgical findings and postoperative complications
including relapses.
Nuno Lousan Results: Ninety-four patients (97 surgical
Unidade Local de Saúde do Tâmega e Sousa,
Portugal procedures) with chronic otitis media with
cholesteatoma were included. Of these, 43 were
submitted to a canal-wall-down mastoidectomy,
52 to a canal-wall-up and 2 were managed with
an atticotomy. Regarding tympanoplasties,
21.6% underwent a Portmann type 1 procedure,
41.2% a type 2 and 37.1% a type 3. There was an
average pure tone average loss of 0.2 dB for wall-
up procedures and 1,1 dB for wall-down with an
average improvement of 11.8 dB for atticotomies.
The overall relapse rate was 21.6% with 9.3% in the
wall-down group, 30.8% in the wall-up group and
50% in cases where an atticotomy was performed.
Conclusion: Cholesteatoma surgery requires a
highly individualized assessment that considers
the extension of the disease, audiometric
parameters, surgeon experience and patient
receptivity. This study revealed no significant
difference in hearing results for both wall-up and
wall-down while it favors wall-down surgeries for a
safer eradication of the disease.
Keywords: Cholesteatoma; Canal wall up; Canal wall
down; Tympanoplasty; Tympano-mastoidectomy;
Hearing gain; Recidivism
Correspondência:
Simão Bessa Introduction
75414@chts.min-saude.pt
Chronic otitis media with cholesteatoma
(COM-wC) is defined as a “mass formed
Artigo recebido a 25 de Abril de 2024.
Aceite para publicação a 31 de Dezembro de 2024. by keratinizing squamous epithelium in
the middle ear subepithelial connective

Volume 63 . Nº2 . Junho 2025 161