European Archives of Oto-Rhino-Laryngology

, Volume 272, Issue 11, pp 3177–3185 | Cite as

Health-related quality of life measurement after cholesteatoma surgery: comparison of three different surgical techniques

  • Susen Lailach
  • Max Kemper
  • Nikoloz Lasurashvili
  • Thomas Beleites
  • Thomas Zahnert
  • Marcus Neudert


The objective of this study was to compare health-related quality of life (HRQOL) after sequential cholesteatoma surgery including exclusively transcanal technique (ETC), combined transcanal transmastoidal technique (TCM) and canal wall down surgery with obliteration (CWD). It was a clinical case study conducted in a tertiary referral center. 97 patients at least 12 months after cholesteatoma surgery were included. Interventions included sequential cholesteatoma surgery with ETC, TCM or CWD; ossiculoplasty with partial and total ossicular replacement prostheses. HRQOL assessed by Chronic Otitis Media Outcome Test 15 including an overall score and three subscores (‘ear symptoms’, ‘hearing function’ and ‘mental health’) as well as a general evaluation of HRQOL and the frequency of physician consultations, audiometric outcome related to HRQOL were the main outcome measures. Patients, who had undergone sequential cholesteatoma surgery, showed moderate restrictions in HRQOL postoperatively. Stratified for the three surgical techniques, patients receiving ETC tended to report lower restrictions in HRQOL. The ETC group offered a significantly lower value in the subscore ‘ear symptoms’. The ‘hearing function’ was attributed to be the most restriction criteria for all techniques. The overall score and all subscores correlated moderately with the postoperative air conduction threshold. The strongest correlation coefficient was achieved for the subscore ‘hearing function’ (r s = 0.49, p < 0.001). Sequential cholesteatoma surgery offers acceptable moderate restrictions in HRQOL postoperatively. Patients receiving canal wall down surgery with obliteration showed equivalent limitations in HRQOL compared to closed techniques (ETC, TCM). The postoperative air conduction threshold was shown not to be a sufficient indicator for HRQOL. Therefore, disease-specific validated and reliable measuring instruments for HRQOL should be transferred from clinical research to clinical practice to provide an individualized postoperative assessment after cholesteatoma surgery.


Health-related quality of life Cholesteatoma Surgical technique Intact canal wall Canal wall down 


Conflict of interest

The authors report no conflicts of interest.


  1. 1.
    Brown JS (1982) A ten year statistical follow-up of 1142 consecutive cases of cholesteatoma: the closed vs. the open technique. Laryngoscope 92(4):390–396CrossRefPubMedGoogle Scholar
  2. 2.
    Charachon R, Gratacap B, Tixier C (1988) Closed versus obliteration technique in cholesteatoma surgery. Am J Otol 9(4):286–292PubMedGoogle Scholar
  3. 3.
    Quaranta A, Cassano P, Carbonara G (1988) Cholesteatoma surgery: open vs closed tympanoplasty. Am J Otol 9(3):229–231PubMedGoogle Scholar
  4. 4.
    Nyrop M, Bonding P (1997) Extensive cholesteatoma: long-term results of three surgical techniques. J Laryngol Otol 111(6):521–526CrossRefPubMedGoogle Scholar
  5. 5.
    Vartiainen E, Nuutinen J (1993) Long-term results of surgical treatment in different cholesteatoma types. Am J Otol 14(5):507–511PubMedGoogle Scholar
  6. 6.
    Duckert LG, Makielski KH, Helms J (2002) Management of anterior epitympanic cholesteatoma: expectations after epitympanic approach and canal wall reconstruction. Otol Neurotol 23(1):8–13CrossRefPubMedGoogle Scholar
  7. 7.
    Donald PJ, Baker SR (1979) Hearing results following atticotomy. Laryngoscope 89(2 Pt 1):195–203PubMedGoogle Scholar
  8. 8.
    Stankovic MD (2008) Audiologic results of surgery for cholesteatoma: short- and long-term follow-up of influential factors. Otol Neurotol 29(7):933–940CrossRefPubMedGoogle Scholar
  9. 9.
    Palva T (1987) Surgical treatment of chronic middle ear disease. II. Canal wall up and canal wall down procedures. Acta Otolaryngol 104(5–6):487–494CrossRefPubMedGoogle Scholar
  10. 10.
    Schmerber S, Troussier J, Dumas G, Lavieille JP, Nguyen DQ (2006) Hearing results with the titanium ossicular replacement prostheses. Eur Arch Otorhinolaryngol 263(4):347–354CrossRefPubMedGoogle Scholar
  11. 11.
    De Vos C, Gersdorff M, Gerard JM (2007) Prognostic factors in ossiculoplasty. Otol Neurotol 28(1):61–67CrossRefPubMedGoogle Scholar
  12. 12.
    Baumann I, Gerendas B, Plinkert PK, Praetorius M (2011) General and disease-specific quality of life in patients with chronic suppurative otitis media–a prospective study. Health Qual Life Outcomes 9:48PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Nadol JB Jr, Staecker H, Gliklich RE (2000) Outcomes assessment for chronic otitis media: the Chronic Ear Survey. Laryngoscope 110(3 Pt 3):32–35CrossRefPubMedGoogle Scholar
  14. 14.
    Stewart MG, Coker NJ, Jenkins HA, Manolidis S, Bautista MH (2000) Outcomes and quality of life in conductive hearing loss. Otolaryngol Head Neck Surg 123(5):527–532CrossRefPubMedGoogle Scholar
  15. 15.
    Korsten-Meijer AG, Wit HP, Albers FW (2006) Evaluation of the relation between audiometric and psychometric measures of hearing after tympanoplasty. Eur Arch Otorhinolaryngol 263(3):256–262CrossRefPubMedGoogle Scholar
  16. 16.
    Newman CW, Weinstein BE (1988) The Hearing Handicap Inventory for the Elderly as a measure of hearing aid benefit. Ear Hear 9(2):81–85CrossRefPubMedGoogle Scholar
  17. 17.
    Baumann I (2009) Research on quality of life in ear, nose, and throat medicine. HNO 57(9):855–856CrossRefPubMedGoogle Scholar
  18. 18.
    Baumann I, Kurpiers B, Plinkert PK, Praetorius M (2009) Development and validation of the Chronic Otitis Media Outcome Test 15 (COMOT-15). Measurement of health-related quality of life in patients with chronic otitis media. HNO 57(9):889–895CrossRefPubMedGoogle Scholar
  19. 19.
    Phillips JS, Haggard M, Yung M (2014) A New Health-Related Quality of Life Measure for Active Chronic Otitis Media (COMQ-12): development and Initial Validation. Otol Neurotol 35(3):454–458CrossRefPubMedGoogle Scholar
  20. 20.
    Vlastos IM, Kandiloros D, Manolopoulos L, Ferekidis E, Yiotakis I (2009) Quality of life in children with chronic suppurative otitis media with or without cholesteatoma. Int J Pediatr Otorhinolaryngol 73(3):363–369CrossRefPubMedGoogle Scholar
  21. 21.
    Wang PC, Chu CC, Liang SC, Tai CJ, Gliklich RE (2003) Validation assessment of the Chinese-version Chronic Ear Survey: a comparison between data from English and Chinese versions. Ann Otol Rhinol Laryngol 112(1):85–90CrossRefPubMedGoogle Scholar
  22. 22.
    Choi SY, Cho YS, Lee NJ, Lee J, Chung WH, Hong SH (2012) Factors associated with quality of life after ear surgery in patients with chronic otitis media. Arch Otolaryngol Head Neck Surg 138(9):840–845CrossRefPubMedGoogle Scholar
  23. 23.
    Committee on Hearing and Equilibrium (1995) Committee on Hearing and Equilibrium guidelines for the evaluation of results of treatment of conductive hearing loss. Otolaryngol Head Neck Surg 113(3):186–187CrossRefGoogle Scholar
  24. 24.
    Quaranta N, Iannuzzi L, Petrone P, D’Elia A, Quaranta A (2014) Quality of life after cholesteatoma surgery: intact-canal wall tympanoplasty versus canal wall-down tympanoplasty with mastoid obliteration. Ann Otol Rhinol Laryngol 123(2):89–93CrossRefPubMedGoogle Scholar
  25. 25.
    Neudert M, Lailach S, Lasurashvili N, Kemper M, Beleites T, Zahnert T. Cholesteatoma Recidivism: Comparison of three different surgical techniques. Otol Neurotol. [Epub ahead of print]Google Scholar
  26. 26.
    Kurien G, Greeff K, Gomaa N, Ho A (2013) Mastoidectomy and mastoid obliteration with autologous bone graft: a quality of life study. J Otolaryngol Head Neck Surg 42(1):49PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Clark MP, Bottrill I (2007) SerenoCem -glass ionomeric granules: a 3-year follow-up assessment of their effectiveness in mastoid obliteration. Clin Otolaryngol 32(4):287–290CrossRefPubMedGoogle Scholar
  28. 28.
    Stoor P, Pulkkinen J, Grenman R (2010) Bioactive glass S53P4 in the filling of cavities in the mastoid cell area in surgery for chronic otitis media. Ann Otol Rhinol Laryngol 119(6):377–382PubMedGoogle Scholar
  29. 29.
    Dornhoffer JL (1999) Surgical modification of the difficult mastoid cavity. Otolaryngol Head Neck Surg 120(3):361–367CrossRefPubMedGoogle Scholar
  30. 30.
    Farrior JB (1998) Postauricular myocutaneous flap in otologic surgery. Otolaryngol Head Neck Surg 118(6):743–746CrossRefPubMedGoogle Scholar
  31. 31.
    Bakir S, Kinis V, Bez Y et al (2013) Mental health and quality of life in patients with chronic otitis media. Eur Arch Otorhinolaryngol 270(2):521–526CrossRefPubMedGoogle Scholar
  32. 32.
    Carr AJ, Gibson B, Robinson PG (2001) Measuring quality of life: is quality of life determined by expectations or experience? BMJ 322(7296):1240–1243PubMedCentralCrossRefPubMedGoogle Scholar
  33. 33.
    Smyth GD, Patterson CC (1985) Results of middle ear reconstruction: do patients and surgeons agree? Am J Otol 6(3):276–279PubMedGoogle Scholar
  34. 34.
    Gardner EK, Jackson CG, Kaylie DM (2004) Results with titanium ossicular reconstruction prostheses. Laryngoscope 114(1):65–70CrossRefPubMedGoogle Scholar
  35. 35.
    Alaani A, Raut VV (2010) Kurz titanium prosthesis ossiculoplasty–follow-up statistical analysis of factors affecting one year hearing results. Auris Nasus Larynx 37(2):150–154CrossRefPubMedGoogle Scholar
  36. 36.
    Mardassi A, Deveze A, Sanjuan M et al (2011) Titanium ossicular chain replacement prostheses: prognostic factors and preliminary functional results. Eur Ann Otorhinolaryngol Head Neck Dis 128(2):53–58CrossRefPubMedGoogle Scholar
  37. 37.
    Jung KH, Cho YS, Hong SH, Chung WH, Lee GJ, Hong SD (2010) Quality-of-life assessment after primary and revision ear surgery using the chronic ear survey. Arch Otolaryngol Head Neck Surg 136(4):358–365CrossRefPubMedGoogle Scholar
  38. 38.
    Herschbach P (2002) The “Well-being paradox” in quality-of-life research. Psychother Psychosom Med Psychol 52(3–4):141–150CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Susen Lailach
    • 1
  • Max Kemper
    • 1
  • Nikoloz Lasurashvili
    • 1
  • Thomas Beleites
    • 1
  • Thomas Zahnert
    • 1
  • Marcus Neudert
    • 1
  1. 1.Department of Otorhinolaryngology, Head and Neck SurgeryTechnische Universität Dresden, Medizinische Fakultät Carl Gustav CarusDresdenGermany

Personalised recommendations