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Multi-operated cholesteatoma: when two surgeries are not enough

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Most studies regarding residual and recurrent cholesteatoma focus on single relapse. This study examines patients who had to undergo at least three surgeries for complete eradication of their cholesteatoma, with the aim of bringing to light risk factors and assessing the functional impact of multiple surgeries on hearing.

Method

We include 27 patients who underwent 3 consecutive surgeries for cholesteatoma between 2006 and 2016. This population represented 3.1% of all cholesteatoma operated on during that same period (868 patients).

Results

Cases of multi-residual and/or recurrent cholesteatoma (RRC) were significantly younger (13.1 years old), than single-RRC or cases with No-RRC (respectively, 28.0 and 38.5 years old) (p < 0.01). Furthermore, there was a significant difference in cholesteatoma location especially for combined attical and mesotympanic location between the three groups (no-RCC 26%; single-RRC 34% and multi-RRC 66%) (p < 0.01). There was also a significant difference in ossicular erosion of the malleus, incus and stapes between the three groups (p < 0.01). In our study, the type of surgery did not influence multi-RRC rates. We did not observe any significant impact on hearing between the first and third surgeries. Mean duration between the first and second surgeries was significantly shorter for multi-RRC (14.5 months SD 8.3) than for single-RRC (23.3 months SD 18.1) (p < 0.05).

Conclusion

Special care should be given in case of combined attical and mesotympanic extension, ossicular erosion and young children. Delaying the realization of MRI, and/or of second-look surgery, could decrease the risk of multi-RRC.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Acknowledgements

We would like to thank all the patients who participated in this study. We would also like to thank all the surgeons who contributed to this study, especially Dr. Sonia Ayari-Khalfallah. Finally we would like to thank Dr. Margaux Grall for helping with the writing of the manuscript and Dr. Gunther Huyghues des Etages for helping with data collection.

Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. ENT and Cervico-Facial Surgery Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 place d’Arsonval, 69437, Lyon Cedex 03, France

    Ruben Hermann, Gauvain Desternes, Aurélie Coudert & Eric Truy

  2. University Claude Bernard Lyon 1, Lyon, France

    Ruben Hermann, Maxime Fieux, Gauvain Desternes, Aurélie Coudert & Eric Truy

  3. Department of Otolaryngology-Head and Neck Surgery, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France

    Jacques Blanc

  4. Department of Otology and Otoneurology, Lyon Sud Hospital, Hospice Civils de Lyon, Lyon, France

    Maxime Fieux

Authors
  1. Ruben Hermann
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  2. Jacques Blanc
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  3. Maxime Fieux
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  4. Gauvain Desternes
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Corresponding author

Correspondence to Ruben Hermann.

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Conflict of interest

None of the authors declare any conflict of interest.

Ethical approval

This study complies with the ethical and legal requirements of the French law (March 5, 2012) and the Declaration of Helsinki. Approval from the Ethics comity of the Lyon University Hospital was received for this study (no. 20-05).

Informed consent

In accordance with French law (March 5, 2012) with regards to research limited to gathering retrospective data stemming from medical files, all patients were informed that they had the right to refuse that their data or information be used in this study.

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Hermann, R., Blanc, J., Fieux, M. et al. Multi-operated cholesteatoma: when two surgeries are not enough. Eur Arch Otorhinolaryngol 278, 665–673 (2021). https://doi.org/10.1007/s00405-020-06104-6

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  • DOI: https://doi.org/10.1007/s00405-020-06104-6

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