This is a retrospective study of patients with external auditory canal cholesteatoma (EACC) managed at a single tertiary centre from 1 January 2010 to 1 January 2021. Ninety patients (100 ears) were included. Mean age at diagnosis was 56+23 years. The most common associated comorbidities were tobacco use and cerumen impaction requiring debridement. The most common site of EACC was in the inferior (32%) and anterior-inferior (18%) quadrant. Most were at Naim stage three (EACC with bony erosion into the adjacent bony canal) (49%). With regards to the type of intervention, disease stage, age, sex or race was not associated with a difference in conservative versus surgical management across disease stages two to four. Surgical intervention was performed in 81 ears (81%), most commonly a canalplasty / tympanoplasty. Patients without symptoms had lower odds of surgical management. Canalplasty / tympanoplasty was a more common (79%) surgical treatment than mastoidectomy. Anterior and inferior EACC had lower odds of mastoidectomy compared to posterior EACC. Of 100 ears, 18% experienced recurrence with a mean duration of 1.55 years and a maximum duration of 4.8 years. The authors propose a treatment algorithm considering the stage of disease, patient symptoms and location of EACC. Surgical treatment in the form of a canalplasty / tympanoplasty or mastoidectomy is suggested for EACC associated with bony erosion while debridement may be appropriate if there is no bony erosion. Surveillance, which involves routine exams, should be up to five years from the surgery date. Recurrences may be addressed with debridement, whether in office or in theatre.
Canal cholesteatoma
Reviewed by Richard (Wei Chern) Gan
Canal Cholesteatomas: Proposed Guidelines Based on Otologic Practicesat a Tertiary Care Center.
CONTRIBUTOR
Richard (Wei Chern) Gan
Hull University Teaching Hospitals NHS Trust, UK.
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