Page 65 - Revista Portuguesa - SPORL - Vol 63. Nº2
P. 65
Chart 6 as the mean time of follow-up due to otologic
Distribution of patients at the time of review complaints before surgery was 21,5 months.
Additionally, from pre-operative assessments
it is important to note that most patients
had sclerotic mastoids (73,6%), type C or B
contralateral tympanograms (51.7% of cases),
and otoscopy mostly revealed attic tunnels
(66.1%) and retractions pockets of the posterior
pars tensa (25.7 %), all findings supporting
a preexisting impairment in middle ear
ventilation. Preoperative audiometry revealed
no significant relationship between the
degree of hearing loss and the extent of the
disease classified by the STAM system, but
rather with the erosion of the ossicular chain,
more specifically whether the supra-structure
of the stapes was affected or not. There are
multiple complex mechanisms that come into
play regarding the cholesteatoma effect on
hearing. While cholesteatomas could impair
Discussion hearing function due to changes in middle
Surgery remains the mainstay of treatment ear resonance and limitation of the vibratory
for COM-wC. Literature reviews on this capacity of the ossicular chain or tympanic
subject reveal a panoply of different surgical membrane , it may also act as a transmission
10
approaches which have evolved from radical bridge of acoustic energy, resulting in
mastoidectomies to the more preserving and narrowed air-bone gaps.
11
reconstructive tympano-mastoidectomies. Up The association between the degree of
to date, there is still no consensus about the hearing loss and ossicular chain erosion in
best possible intervention for each individual cases of COM-wC remains controversial. While
case. However, controversy surrounding some reports suggest that hearing loss is not
cholesteatoma goes beyond the debate a good predictor of ossicular chain status 11,12 ,
around its surgical management. In fact, there a different study and our review describe
10
is still a debate about the pathophysiological a correlation. There are different features
processes that give rise to it and innumerous generally attributable to each type of surgery.
theories have been developed. The most widely CWD mastoidectomies have the advantage
accepted for primary acquired cholesteatoma of better visibility and access to more difficult
(the main bulk of cases encountered in this sites, providing a more consistent complete
review) is the retraction theory, in which a removal of the disease. However, they are
slow ingrowth of squamous epithelium enters associated with higher occurrences of non-
the middle ear from a retraction pocket of the self-cleaning cavities which may require
tympanic membrane due to a dysregulation in regular follow-up visits, water restrictions and
middle ear pressure. As for secondary acquired special molds for hearing aids. Those who
2
cholesteatomas, literature supports that they favor CWU approaches argue that complete
may develop due to migration of keratin eradication of the disease can be achieved in
epithelium through a tympanic membrane most cases with this technique, and patients
perforation or temporal bone fracture. In will benefit from a better quality of life during
2
this series, regarding etiopathogenesis, it follow-up due to a self-cleaning ear.
became clear the chronicity of this disease, In our practice, a general preference was given
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