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tissue, with progressive accumulation of criteria were applied to patients with a follow-
keratin debris with/without surrounding up period of less than one year and patients
inflammatory reaction” which can cause in which relevant data were not available
1
significant impairment, if left untreated. in the hospital computer system, such as
Due to its local inflammatory and destructive audiograms and radiological results.
characteristics, it can lead to complications All patients underwent an audiometric and
such as facial nerve paralysis, temporal bone/ temporal bone CT scan evaluation prior to
intracranial infections, and erosion of the surgery. After intervention, clinical surveillance
ossicular chain and otic capsule affecting was carried out regularly with otoscopy
hearing and vestibular function. 2 examinations and an initial audiometry
To this day, surgery remains the mainstay was performed between 3 to 6 months in
of treatment. The main goals are complete all patients. Additionally, in cases of wall-up
eradication of the disease, maintenance procedures, a high-resolution CT scan of the
of an epithelialized, self-cleaning ear and temporal bone was routinely performed after
preservation of hearing. However, there is no 2 years. Whenever a non-specific soft tissue
2-4
consensus about the best surgical technique density was found an additional diffusion-
from the innumerous described and surgeons weighted MRI was requested.
still struggle when it comes to decide the right Preoperative data was collected regarding
approach for each individual case. age, sex, time of follow-up before surgery,
Many factors come into play regarding this previous otologic interventions, mastoid
decision-making process, those include pneumatization from CT scans, contralateral
extension of disease, anatomical factors tympanogram (as a proxy for middle ear
conditioning accessibility during surgery, ventilation) and audiometric results including
comorbidities, age, socioeconomic condition, the air-bone (A-B) gap and pure tone average
collaboration of the patient and surgeon (PTA) for air conduction at 500, 1000, 2000
expertise. 2,3,5,6 Surgical procedures can be & 4000 Hz performed within the 6 months
largely categorized by the preservation or not before surgery. At the time of surgery, the
of the posterior bony external auditory canal extension of cholesteatoma was classified
(EAC) wall, as canal wall up (CWU) or canal wall according to the STAM classification system
8
down (CWD) mastoidectomies and regarding in which the middle ear and mastoid space are
the type of ossicular reconstruction including divided into four sites: tympanic cavity (T), attic
which interposition material used. 2,7 In this (A), mastoid (M) and the difficult access sites,
study, we performed a 10-year retrospective supratubal recess (S1) and the sinus tympani
review of our experience regarding the surgical (S2). Other intraoperative assessments such as
management of COM-wC in a peripheral otoscopic findings, dehiscence of the facial or
hospital, comparing preoperative and lateral semicircular canals and erosion of the
postoperative parameters and the functional tegmen tympani were also registered.
outcomes of different surgical approaches. Surgeries mainly consisted in the combination
of tympanoplasties and mastoidectomies,
Material and Methods wall up or down. Decisions regarding
We performed a 10-year retrospective review preservation of the posterior wall of the EAC
of digitized institutional medical records from were mostly made intraoperatively. The wall
patients undergoing surgical intervention for down variant was the preferred method in
COM-wC at ULSTS hospital, Portugal, between cases with extensive cholesteatoma, poor
1 January 2012 and 31 December 2022. access to certain areas of the mastoid, small
Inclusion criteria comprised all patients mastoid volumes and relapses. Additionally,
submitted to surgery for treatment of COM- atticotomies were also performed in cases
wC during the mentioned period. Exclusion of small attic cholesteatomas in which only
162 Revista Portuguesa de Otorrinolaringologia - Cirurgia de Cabeça e Pescoço
