Is Cholesteatoma a Risk Factor for Graft Success Rate in Chronic Otitis Media Surgery?

Document Type: Original

Authors

1 Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

2 Health Policy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Abstract

Introduction:
In developing countries, chronic otitis media (COM) and cholesteatoma are relatively prevalent.  Within the field of otology, COM surgery remains one of the most common surgical treatments. Most recent studies evaluating the potential prognostic factors in COM surgery have addressed graft success rate and types of middle ear and mastoid pathology. There has been much controversy about this issue until the present time. This study evaluated the effect of cholesteatoma on the GSR in COM surgery.
 
Materials and Methods:
The present retrospective, study-controlled study investigated 422 ears undergoing COM surgery. The minimum and maximum postoperative follow-up periods were 6 and 48 months, respectively. The study group consisted of patients with cholesteatomatous COM, while the control group included patients with non-cholesteatomatous COM, who had undergone ear surgery.  Postoperative graft success rate and audiological test results were recorded and the effect of cholesteatoma on graft success rate was investigated.
 Results:
The overall GSR was 92.4%. In the study group (COM with cholesteatoma),the postoperative GSR, mean speech reception threshold improvement, and mean air-bone gap gain were 95.3%, 2.1 dB, and 3.2 dB, respectively. In the control group (COM without cholesteatoma), however, these measurements were 90.9%, 9.4 dB, and 9.1 dB, respectively. The difference between the two groups was not statistically significant.
 Conclusion: 
The study results suggest that cholesteatoma is not a significant prognostic factor in graft success rate.

Keywords

Main Subjects


1. Smith JA, Danner CJ. Complications of chronic otitis media and cholesteatoma. Otolaryngol Clin North Am 2006;39(6):1237–55.

2. Cruz OL, Kasse CA, Leonhart FD. Efficacy of surgical treatment of chronic otitis media. Otolaryngol Head Neck Surg  2003;128(2):263–6.

3. Kemppainen HO, Puhakka HJ, Laippala PJ, Sipila MM, Manninen MP, Karma PH. Epidemiology and aetiology of middle ear cholesteatoma. Acta Otolaryngol 1999; 119(5):568–72.

4. Bailey BJ, Johnson JT, Newlands SD. Head & neck surgery–otolaryngology: Lippincott Williams & Wilkins; 2006.

5. Becvarovski Z, Kartush JM. Smoking and tympanoplasty: implications for prognosis and the Middle Ear Risk Index (MERI). Laryngoscope 2001; 111(10):1806–11.

6. Sarker MZ, Ahmed M, Patwary K, Islam R, Joarder AH. Factors affecting surgical outcome of myringoplasty. Bangladesh J Otorhinolaryngol 2011; 17(2):82–7.

7. Lee P, Kelly G, Mills RP. Myringoplasty: does the size of the perforation matter? Clin Otolaryngol Allied Sci 2002; 27(5):331–4.

8. Emir H, Ceylan K, Kizilkaya Z, Gocmen H, Uzunkulaoglu H, Samim E. Success is a matter of experience: type 1 tympanoplasty: influencing factors on type 1 tympanoplasty. Eur Arch Otorhinolaryngol 2007; 264(6):595–9.

9. Vrabec JT, Deskin RW, Grady JJ. Meta-analysis of pediatric tympanoplasty. Arch Otolaryngol Head Neck Surg 1999; 125(5):530–4.

10. Bhat NA, De R. Retrospective analysis of surgical outcome, symptom changes, and hearing improvement following myringoplasty. J Otolaryngol 2000; 29(4):229–32.

11. Sheehy JL, Anderson RG. Myringoplasty. A review of 472 cases. Ann Otol Rhinol Laryngol 1980; 89(4 Pt 1):331–4.

12. McGrew BM, Jackson CG, Glasscock ME 3rd. Impact of mastoidectomy on simple tympanic membrane perforation repair. Laryngoscope 2004; 114(3):506–11.

13. Ordóñez-Ordóñez LE, Angulo-Martinez ES, Prieto-Rivera JA, Almario-Chaparro JE, Guzman-Duran JE, Lora-Falquez JG. [Risk factors leading to

failure in myringoplasty: a case-control study]. Acta Otorrinolaringol Esp 2008;59(4):176–82.

14. Mishiro Y, Sakagami M, Kondoh K, Kitahara T, Kakutani C. Long-term outcomes after tympanoplasty with and without mastoidectomy for perforated chronic otitis media. Eur Arch Otorhinolaryngol 2009; 266(6):819–22.

15. Fukuchi I, Cerchiari DP, Garcia E, Rezende CE, Rapoport PB. Tympanoplasty: surgical results and a comparison of the factors that may interfere in their success. Braz J Otorhinolaryngol 2006;72(2):267–71.

16. Sengupta A, Anwar T, Ghosh D, Basak B. A study of surgical management of chronic suppurative otitis media with cholesteatoma and its outcome. Indian J Otolaryngol Head Neck Surg 2010; 62(2): 171–6.

17. Zhang ZG, Liu X, Chen SJ, Chen B, Zheng YQ. Modification of closed tympanoplasty in middle ear cholesteatoma. Chin Med J(Engl)2010;123(4):447-51.

18. Merchant SN, Wang P, Jang CH, Glynn RJ, Rauch SD, McKenna MJ, et al. Efficacy of tympanomastoid surgery for control of infection in active chronic otitis media. Laryngoscope 1997; 107(7):872–7.

19. Pinar E, Sadullahoglu K, Calli C, Oncel S. Evaluation of prognostic factors and middle ear risk index in tympanoplasty. Otolaryngol Head Neck Surg  2008; 139(3):386–90.

20. Gersdorff M, Garin P, Decat M, Juantegui M. Myringoplasty: long-term results in adults and children. Am J Otol 1995;16(4):532–5.

21. Balyan FR, Celikkanat S, Aslan A, Taibah A, Russo A, Sanna M. Mastoidectomy in noncholes teatomatous chronic suppurative otitis media:  is it necessary? Otolaryngol Head Neck Surg 1997; 117(6):592–5.

22. Yaor M, El-Kholy A, Jafari B. Surgical management of chronic suppurative otitis media: a 3-year experience. Ann African Med 2006; 5(1):24–7.