Abstract
Purpose
To report our experience of a sequence of events that resulted in an iatrogenic cholesteatoma originating from the external auditory canal (EAC) years after tympanoplasty that had included a tympanomeatal flap.
Methods
Data on the presentation and pathogenesis of iatrogenic cholesteatomas arising from misplaced tympanomeatal flaps during tympanoplasty without mastoidectomy were retrieved from the patients’ medical records and analyzed.
Results
Five patients were identified with cholesteatomas involving the EAC. They all had recurrent ear infections and varying degrees of conductive hearing loss. Each patient’s past surgical history included one or more tympanoplasties in which an ipsilateral tympanomeatal flap had been raised. None had undergone a mastoidectomy. Two patients presented with small cholesteatomas that had developed over an average of 6.5 years after surgery. Three patients had large cholesteatomas that had developed over an average of 33.7 years after surgery. Clinical presentations and imaging studies suggested a misplaced tympanomeatal flap as the most likely source of cholesteatoma.
Conclusion
Tympanomeatal flap misplacement may cause iatrogenic cholesteatoma formation originating from the EAC during tympanoplasty even without mastoidectomy. These cholesteatomas can grow substantially before becoming symptomatic as they extend to and through the mastoid. They may not affect the sound conduction system until late in the course of the disease. Meticulous replacement of tympanomeatal flaps and exercising a high index of suspicion postoperatively can reduce the incidence of this complication.
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References
Wullstein H (1956) Theory and practice of tympanoplasty. Laryngoscope 66:1076–1093
Bailey BJ (2001) Atlas of head and neck surgery—otolaryngology, 2nd edn. Lippincott, Williams, and Wilkins, Baltimore
Cronin SJ, El-Kashlan HK, Telian SA (2014) Iatrogenic cholesteatoma arising at the bony-cartilaginous junction of the external auditory canal: a late sequela of intact canal wall mastoidectomy. Otol Neurotol 35:215–221
Viswanatha B (2009) External auditory canal cholesteatoma: a rare complication of tympanoplasty. Ear Nose Throat J 88:1206–1209
Owen HH, Rosborg J, Gaihede M (2006) Cholesteatoma of the external ear canal: etiological factors, symptoms and clinical findings in a series of 48 cases. BMC Ear Nose Throat Disorders 6(1):16
Fisch U (2008) Specific surgical techniques for cholesteatoma removal, in tympanoplasty, mastoidectomy and stapes surgery. Thieme, Stuttgart, p 163
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Tel Aviv Medical Center ethics committee, number 0063-17-TLV) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Ungar, O.J., Cavel, O., Wasserzug, O. et al. Iatrogenic cholesteatoma originating from a misplaced tympanomeatal flap during tympanoplasty: a series of five patients. Eur Arch Otorhinolaryngol 277, 3295–3299 (2020). https://doi.org/10.1007/s00405-020-06039-y
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DOI: https://doi.org/10.1007/s00405-020-06039-y