European Journal of Plastic Surgery

, Volume 39, Issue 4, pp 307–312 | Cite as

Intralesional cryosurgery for the treatment of keloid scars following cochlear implant surgery and removal of cholesteatoma

Case Report


The development of hypertrophic scars and keloids is a relatively common complication of different otologic procedures involving incision of the skin behind the ear. This case report aims to describe the successful treatment of keloids that developed following ear surgeries that have been performed via a retro-auricular approach (cochlear implantation and the removal of cholesteatoma) by an intralesional cryosurgery method. Two patients who were previously operated for an extensive pediatric cholesteatoma and one patient who underwent a cochlear implant surgery have developed large keloids at the radix helix. The keloids were treated under local anesthesia by the intralesional cryosurgery method. Over a 6-month period, the scars gradually flattened and became paler and the clinical symptoms of itchiness, pain, and tenderness have significantly been reduced. No complications were documented, and there were no recurrences in a follow-up period of 30 months. This case report demonstrates that intralesional cryosurgery provides the surgeon with an effective method to treat keloid scars following the removal of cholesteatoma or cochlear implantation, thus improving the quality of life and body image and enabling the patients to use the implanted device in an adequate and satisfactory way.

Level of Evidence: Level V, therapeutic study.


Keloid Intralesional cryosurgery Otologic surgery Cholesteatoma Cochlear implant surgery 


  1. 1.
    Ajalloueyan M, Amirsalari S, Yousefi J, Raeesi MA, Radfar S, Hassanalifard M (2011) A report of surgical complications in a series of 262 consecutive pediatric cochlear implantations in Iran. Iran J Pediatr 21:455–60Google Scholar
  2. 2.
    Kempf HG, Johann K, Lenarz T (1999) Complications in pediatric cochlear implant surgery. Eur Arch Otorhinolaryngol 256:128–32CrossRefPubMedGoogle Scholar
  3. 3.
    Loochtan MJ, Yang S, Mantravadi AV, Marzo SJ (2014) Cochlear implant extrusion secondary to keloid formation. Cochlear Implants Int 15:276–8CrossRefPubMedGoogle Scholar
  4. 4.
    Tunkel DE (2006) The Z-meatoplasty for modified radical mastoidectomy in children. Arch Otolaryngol Head Neck Surg 132:1319–1322CrossRefPubMedGoogle Scholar
  5. 5.
    Backer DC, Converse JM (1979) Correction of protruding ears: a 20-year retrospective. Aesthetic Plast Surg 3:29–39CrossRefGoogle Scholar
  6. 6.
    Leist SD, Masson JK, Erich JB (1977) A review of 324 rhytidectomies emphasizing complications and patient dissatisfaction. Plast Reconstr Surg 59:525–529CrossRefPubMedGoogle Scholar
  7. 7.
    Park TH, Chang CH (2015) Location of keloids and its treatment modality may influence the keloid recurrence in children. J Craniofac Surg 26:1355–1357CrossRefPubMedGoogle Scholar
  8. 8.
    Carvalho B, Ballin AC, Becker RV, Ribeiro TB, Cavichiolo JB, Ballin CR, Mocellin M (2012) Treatment of retroauricular keloids: revision of cases treated at the ENT service of HC/UFPR. Int Arch Otorhinolaryngol 16:195–200PubMedPubMedCentralGoogle Scholar
  9. 9.
    Strohm M (2002) Acquired fibrotic atresia of external auditory canal. Laryngorhinootologie 81:8–13CrossRefPubMedGoogle Scholar
  10. 10.
    Har-Shai Y, Amar M, Sabo E (2003) Intralesional cryotherapy for enhancing the involution of hypertrophic scars and keloids. Plast Reconstr Surg 111:1841–1852CrossRefPubMedGoogle Scholar
  11. 11.
    Har-Shai Y, Dujovny E, Rohde E, Zouboulis CC (2007) Effect of skin surface temperature on skin pigmentation during contact and intralesional cryosurgery of keloids. J Eur Acad Dermatol Venereol 21:191–198CrossRefPubMedGoogle Scholar
  12. 12.
    Har-Shai Y, Brown W, Labbe D, Dompmartin A, Goldine I, Gil T, Mettanes I, Pallua N (2008) Intralesional cryosurgery for the treatment of hypertrophic scars and keloids following aesthetic surgery: the results of a prospective observational study. Int J Low Extrem Wounds 7:169–175CrossRefPubMedGoogle Scholar
  13. 13.
    Har-Shai Y, Mettanes I, Zilberstein Y, Genin O, Spector I, Pines M (2011) Keloid histopathology after intralesional cryosurgery treatment. J Eur Acad Dermatol Venereol 25:1027–1036CrossRefPubMedGoogle Scholar
  14. 14.
    Har-Shai Y, Sabo E, Rohde E, Hayms M, Assaf C, Zouboulis CC (2006) Intralesional cryosurgery markedly enhances the involution of recalcitrant auricular keloids—a new clinical approach supported by experimental studies. Wound Repair Regen 14:18–27CrossRefPubMedGoogle Scholar
  15. 15.
    Stromps J-P, Dunda S, Eppstein R-J, Babic D, Har-Shai Y, Pallua N (2014) Intralesional cryosurgery combined with topical silicone gel sheeting for the treatment of refractory keloids. Dermatol Surg 40:996–1003CrossRefPubMedGoogle Scholar
  16. 16.
    Chopinaud M, Pham A-D, Labbe D, Verneuil L, Gourio C, Dompmartin A (2014) Intralesional cryosurgery to treat keloid scars: results from a retrospective study. Dermatology 229:263–270CrossRefPubMedGoogle Scholar
  17. 17.
    Mirmovich O, Gil T, Lavi I, Goldine I, Mettanes I, Har-Shai Y (2012) Pain evaluation and control during and following the treatment of hypertrophic scars and keloids employing contact and intralesional cryosurgery—a preliminary study. J Eur Acad Dermatol Venereol 26:440–447CrossRefPubMedGoogle Scholar
  18. 18.
    Froelich K, Staudenmaier R, Kleinsasser N, Hagen R (2007) Therapy of auricular keloids: review of different treatment modalities and proposal for therapeutic algorithm. Eur Arch Otorhinolaryngol 264:1497–1508CrossRefPubMedGoogle Scholar
  19. 19.
    Fraccalvieri M, Bogetti P, Salomone M, Di Santo C, Ruka E, Bruschi S, Cryotreatment of keloids: a single Italian institutional experience. Eur J Plast Surg. doi:10.1007/s00238-015-1170-6, Published online November 2015.
  20. 20.
    Keveton JF (2004) Revision mastoidectomy. In: Haberman RS (ed) Middle ear and mastoid surgery, Chapter 11. Thieme New York, New York, p 76Google Scholar
  21. 21.
    Berman B, Perez OA, Konda S et al (2007) A review of the biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and management. Dermatol Surg 33:1291–1303PubMedGoogle Scholar
  22. 22.
    Gage AA (1977) Cryosurgery for cancer of the ear. J Dermatol Surg Oncol 3:417–421CrossRefPubMedGoogle Scholar
  23. 23.
    Ray J, Gibson W, Sanli H (2004) Surgical complications of 844 consecutive cochlear implantation and observations on large versus small incisions. Cochlear Implants Int 5:87–95CrossRefPubMedGoogle Scholar
  24. 24.
    Glasscock ME 3rd (2011) Expenses keep cochlear implants out of reach for millions of individuals with profound hearing loss in poor and emerging countries. Otol Neurotol 32:893–894CrossRefPubMedGoogle Scholar
  25. 25.
    Ajalloueyan M, Amirsalari S, Radfar S, Tavallaee A, Khoshini S (2012) Flap outcome using “C” shaped and “new” incisions in pediatric cochlear implantation. Iran Red Crescent Med J 14:218–221PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Ariel Roitman
    • 1
    • 2
    • 3
  • Michal Luntz
    • 2
    • 4
    • 5
    • 6
  • Yaron Har-Shai
    • 2
    • 3
    • 7
  1. 1.The Department of Otolaryngology, Head and Neck SurgeryTechnion—Israel Institute of TechnologyHaifaIsrael
  2. 2.The Ruth and Bruce Rappaport Faculty of MedicineTechnion—Israel Institute of TechnologyHaifaIsrael
  3. 3.Lady Davis Carmel Medical CenterHaifaIsrael
  4. 4.The Ear and Hearing ProgramTechnion—Israel Institute of TechnologyHaifaIsrael
  5. 5.Department of OtolaryngologyBnai Zion Medical CenterHaifaIsrael
  6. 6.Aram, Advanced Center for Otolaryngology Head and Neck SurgeryAssuta Medical CenterTel AvivIsrael
  7. 7.The Unit of Plastic SurgeryLady Davis Carmel Medical CenterHaifaIsrael

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