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Otology/Neurotology

Primary Acquired Cholesteatoma Outcomes With Endoscopic and Combined Approaches

Monday, October 2, 2023
9:51 AM - 9:57 AM East Coast USA Time
Location: 104BC

    Presenting Author(s)

  • Tyler J. Gathman, MS

    Medical Student
    University of Minnesota Medical School
    Minneapolis, MN, United States

    • Co-Author(s)

  • Bridget E. Ebert, MD

    Resident
    University of Minnesota Department of Otolaryngology
    Minneapolis, MN, United States

  • HD

    Huong M. Dang, BS

    Clinical Research Coordinator
    HealthPartners Institute
    St Paul, MN, United States

  • NA

    Nell R. Adams, MPH

    Clinical Research Supervisor
    HealthPartners Institute
    Saint Paul, MN, United States

  • TH

    Tajanae T. Henderson, BS

    Critical Care Research Intern
    HealthPartners Institute
    South Saint Paul, MN, United States

    • Senior Author(s)

  • Manuela Fina, MD

    Assistant Professor
    University of Minnesota
    Saint Paul, MN, United States

Disclosure(s):
Tyler J. Gathman, MS: No relevant relationships to disclose.
Manuela Fina, MD: No relevant relationships to disclose.
Introduction: In this retrospective chart review of pediatric and adult patients with primary acquired cholesteatoma we utilized the EAONO-JOS staging system and STAMCO subsites classification to correlate recidivism following endoscopic and combined approaches.

Methods: 73 surgical ears from 69 patients were operated on between 2015 and 2022 by a senior surgeon in an academic practice and fit inclusion criteria for analysis. Surgeries were subdivided into transcanal endoscopic (TEES), canal wall up (CWU), and canal wall down (CWD) mastoidectomy. Rates of residual disease were evaluated with second look surgery or magnetic resonance imaging (MRI) with diffusion weighted images (DWI) within two years from primary surgery. Rates of recurrent disease were evaluated clinically with a minimum follow up time of two years. Second look surgery was correlated with type of primary surgery performed.

Results: Based on EAONO-JOS staging, 9.8% (n=7) of ears were stage I, 67.6% (n=48) were Stage II, 22.5% (n=16) were Stage III and 0% were stage IV. Primary surgery consisted of TEES in 49.3% of ears (n=36), CWU in 38.4% (n=28) and CWD in 12.3% (n=9). The overall residual rate was 46.6% and overall recurrence rate was 11.0%. Residual in TEES was 38.9% (n=14), CWU was 64.3% (n=18), and CWD was 22.2 % (n=2). Residual disease was detected in 28.6% (n=2) of Stage I, 52.1% (n=25) of Stage II and 43.7% (n=7) of Stage III. Recurrent disease was recorded in 14.3% (n=1) of Stage I, 8.3% (n=4) of Stage II and 18.7% (n=3) of Stage III. Among ears with primary TEES approach requiring second look surgery, only one (2.7%) required a conversion to CWD and among those with primary CWU approach, none were converted to CWD.

Conclusions: In this cohort of primary acquired cholesteatoma with mostly Stage II and III disease, almost half were approached with TEES. The rate of residual disease was higher in TEES than in CWD. Primary TEES correlates with low conversion to CWD (p < .0001). EAONO-JOS staging did not predict residual disease (p=0.53).