A tailored approach in cholesteatoma surgery
Purpose In recent years, new techniques have been added to cholesteatoma surgery, and established microsurgical approaches are being reconsidered. This study aims to present the importance of individualized decision-making for the selection of an intact canal wall (CWU) or canal wall down (CWD) surg...
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| Veröffentlicht in: | European archives of oto-rhino-laryngology 2024-10, Vol.281 (10), p.5189-5198 |
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| creator | Kostadinov, Filip Schlegel-Wagner, Christoph Linder, Thomas |
| description | Purpose
In recent years, new techniques have been added to cholesteatoma surgery, and established microsurgical approaches are being reconsidered. This study aims to present the importance of individualized decision-making for the selection of an intact canal wall (CWU) or canal wall down (CWD) surgical procedure for each patient.
Methods
Using the “ChOLE” classification we categorized 264 operations retrospectively. 162 CWU and 102 CWD surgeries were performed. We focus to determine why a CWD procedure was chosen quite frequently despite some low-stage cases. Furthermore, we evaluated recidivism and hearing outcomes.
Results
Smaller cholesteatomas (Ch-stage 1a, 1b & 2a) were found in 182 patients (70%), ossicular chain status feasible for straightforward reconstruction (O-stage 0, 1 & 2) was present in 186 patients (70%), minor complications due to the cholesteatoma (L-stage 1) were infrequent with 28 cases (11%) and a well-pneumatized mastoid was found in 144 cases (55%). Recidivism rates were low (7%) without any difference in both groups and a mean follow-up time of 4 years and 8 months. In primary surgeries there was a significant difference (
p
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| doi_str_mv | 10.1007/s00405-024-08748-0 |
| format | Article |
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In recent years, new techniques have been added to cholesteatoma surgery, and established microsurgical approaches are being reconsidered. This study aims to present the importance of individualized decision-making for the selection of an intact canal wall (CWU) or canal wall down (CWD) surgical procedure for each patient.
Methods
Using the “ChOLE” classification we categorized 264 operations retrospectively. 162 CWU and 102 CWD surgeries were performed. We focus to determine why a CWD procedure was chosen quite frequently despite some low-stage cases. Furthermore, we evaluated recidivism and hearing outcomes.
Results
Smaller cholesteatomas (Ch-stage 1a, 1b & 2a) were found in 182 patients (70%), ossicular chain status feasible for straightforward reconstruction (O-stage 0, 1 & 2) was present in 186 patients (70%), minor complications due to the cholesteatoma (L-stage 1) were infrequent with 28 cases (11%) and a well-pneumatized mastoid was found in 144 cases (55%). Recidivism rates were low (7%) without any difference in both groups and a mean follow-up time of 4 years and 8 months. In primary surgeries there was a significant difference (
p
< 0.05) in postoperative mean air-bone gap (ABG) between CWU (17dB) and CWD (27dB).
Conclusion
The main goals of cholesteatoma surgery remain the avoidance of recidivism and optimal hearing rehabilitation. We recommend a tailored approach in the treatment of cholesteatomas and not a dogmatic one. Surgeons should not hesitate to perform a CWD procedure if required. Performed correctly it results in a dry ear and CWD surgery should remain in the skill set of the otologic surgeon.</description><identifier>ISSN: 0937-4477</identifier><identifier>ISSN: 1434-4726</identifier><identifier>EISSN: 1434-4726</identifier><identifier>DOI: 10.1007/s00405-024-08748-0</identifier><identifier>PMID: 38809267</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adolescent ; Adult ; Aged ; Child ; Cholesteatoma, Middle Ear - surgery ; Clinical Decision-Making ; Female ; Head and Neck Surgery ; Humans ; Male ; Medicine ; Medicine & Public Health ; Microsurgery - methods ; Middle Aged ; Neurosurgery ; Otologic Surgical Procedures - methods ; Otology ; Otorhinolaryngology ; Retrospective Studies ; Treatment Outcome ; Young Adult</subject><ispartof>European archives of oto-rhino-laryngology, 2024-10, Vol.281 (10), p.5189-5198</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c228t-8d56abb4da7aaad7d945d8ea2bdd380a017dea5cf71fc1018fc76a7bd362e2b13</cites><orcidid>0009-0000-5124-3174</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00405-024-08748-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00405-024-08748-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38809267$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kostadinov, Filip</creatorcontrib><creatorcontrib>Schlegel-Wagner, Christoph</creatorcontrib><creatorcontrib>Linder, Thomas</creatorcontrib><title>A tailored approach in cholesteatoma surgery</title><title>European archives of oto-rhino-laryngology</title><addtitle>Eur Arch Otorhinolaryngol</addtitle><addtitle>Eur Arch Otorhinolaryngol</addtitle><description>Purpose
In recent years, new techniques have been added to cholesteatoma surgery, and established microsurgical approaches are being reconsidered. This study aims to present the importance of individualized decision-making for the selection of an intact canal wall (CWU) or canal wall down (CWD) surgical procedure for each patient.
Methods
Using the “ChOLE” classification we categorized 264 operations retrospectively. 162 CWU and 102 CWD surgeries were performed. We focus to determine why a CWD procedure was chosen quite frequently despite some low-stage cases. Furthermore, we evaluated recidivism and hearing outcomes.
Results
Smaller cholesteatomas (Ch-stage 1a, 1b & 2a) were found in 182 patients (70%), ossicular chain status feasible for straightforward reconstruction (O-stage 0, 1 & 2) was present in 186 patients (70%), minor complications due to the cholesteatoma (L-stage 1) were infrequent with 28 cases (11%) and a well-pneumatized mastoid was found in 144 cases (55%). Recidivism rates were low (7%) without any difference in both groups and a mean follow-up time of 4 years and 8 months. In primary surgeries there was a significant difference (
p
< 0.05) in postoperative mean air-bone gap (ABG) between CWU (17dB) and CWD (27dB).
Conclusion
The main goals of cholesteatoma surgery remain the avoidance of recidivism and optimal hearing rehabilitation. We recommend a tailored approach in the treatment of cholesteatomas and not a dogmatic one. Surgeons should not hesitate to perform a CWD procedure if required. Performed correctly it results in a dry ear and CWD surgery should remain in the skill set of the otologic surgeon.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Child</subject><subject>Cholesteatoma, Middle Ear - surgery</subject><subject>Clinical Decision-Making</subject><subject>Female</subject><subject>Head and Neck Surgery</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Microsurgery - methods</subject><subject>Middle Aged</subject><subject>Neurosurgery</subject><subject>Otologic Surgical Procedures - methods</subject><subject>Otology</subject><subject>Otorhinolaryngology</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0937-4477</issn><issn>1434-4726</issn><issn>1434-4726</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kDtPwzAUhS0EoqXwBxhQRgYM14_EzlghXlIlFpitG9uhqZKm2MnQf48hhZHpDveco3M-Qi4Z3DIAdRcBJOQUuKSgldQUjsicSSGpVLw4JnMohaJSKjUjZzFuACCXpTglM6E1lLxQc3KzzAZs2j54l-FuF3q066zZZnbdtz4OHoe-wyyO4cOH_Tk5qbGN_uJwF-T98eHt_pmuXp9e7pcrajnXA9UuL7CqpEOFiE65UuZOe-SVc0IDAlPOY25rxWrLgOnaqgJV5UTBPa-YWJDrKTf1-RxTDdM10fq2xa3vx2gEFExpLnmZpHyS2tDHGHxtdqHpMOwNA_NNyUyUTKJkfigZSKarQ_5Ydd79WX6xJIGYBDG9tmm62fRj2KbN_8V-ATDXcqs</recordid><startdate>20241001</startdate><enddate>20241001</enddate><creator>Kostadinov, Filip</creator><creator>Schlegel-Wagner, Christoph</creator><creator>Linder, Thomas</creator><general>Springer Berlin Heidelberg</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0009-0000-5124-3174</orcidid></search><sort><creationdate>20241001</creationdate><title>A tailored approach in cholesteatoma surgery</title><author>Kostadinov, Filip ; Schlegel-Wagner, Christoph ; Linder, Thomas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c228t-8d56abb4da7aaad7d945d8ea2bdd380a017dea5cf71fc1018fc76a7bd362e2b13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Child</topic><topic>Cholesteatoma, Middle Ear - surgery</topic><topic>Clinical Decision-Making</topic><topic>Female</topic><topic>Head and Neck Surgery</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Microsurgery - methods</topic><topic>Middle Aged</topic><topic>Neurosurgery</topic><topic>Otologic Surgical Procedures - methods</topic><topic>Otology</topic><topic>Otorhinolaryngology</topic><topic>Retrospective Studies</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kostadinov, Filip</creatorcontrib><creatorcontrib>Schlegel-Wagner, Christoph</creatorcontrib><creatorcontrib>Linder, Thomas</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European archives of oto-rhino-laryngology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kostadinov, Filip</au><au>Schlegel-Wagner, Christoph</au><au>Linder, Thomas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A tailored approach in cholesteatoma surgery</atitle><jtitle>European archives of oto-rhino-laryngology</jtitle><stitle>Eur Arch Otorhinolaryngol</stitle><addtitle>Eur Arch Otorhinolaryngol</addtitle><date>2024-10-01</date><risdate>2024</risdate><volume>281</volume><issue>10</issue><spage>5189</spage><epage>5198</epage><pages>5189-5198</pages><issn>0937-4477</issn><issn>1434-4726</issn><eissn>1434-4726</eissn><abstract>Purpose
In recent years, new techniques have been added to cholesteatoma surgery, and established microsurgical approaches are being reconsidered. This study aims to present the importance of individualized decision-making for the selection of an intact canal wall (CWU) or canal wall down (CWD) surgical procedure for each patient.
Methods
Using the “ChOLE” classification we categorized 264 operations retrospectively. 162 CWU and 102 CWD surgeries were performed. We focus to determine why a CWD procedure was chosen quite frequently despite some low-stage cases. Furthermore, we evaluated recidivism and hearing outcomes.
Results
Smaller cholesteatomas (Ch-stage 1a, 1b & 2a) were found in 182 patients (70%), ossicular chain status feasible for straightforward reconstruction (O-stage 0, 1 & 2) was present in 186 patients (70%), minor complications due to the cholesteatoma (L-stage 1) were infrequent with 28 cases (11%) and a well-pneumatized mastoid was found in 144 cases (55%). Recidivism rates were low (7%) without any difference in both groups and a mean follow-up time of 4 years and 8 months. In primary surgeries there was a significant difference (
p
< 0.05) in postoperative mean air-bone gap (ABG) between CWU (17dB) and CWD (27dB).
Conclusion
The main goals of cholesteatoma surgery remain the avoidance of recidivism and optimal hearing rehabilitation. We recommend a tailored approach in the treatment of cholesteatomas and not a dogmatic one. Surgeons should not hesitate to perform a CWD procedure if required. Performed correctly it results in a dry ear and CWD surgery should remain in the skill set of the otologic surgeon.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>38809267</pmid><doi>10.1007/s00405-024-08748-0</doi><tpages>10</tpages><orcidid>https://orcid.org/0009-0000-5124-3174</orcidid></addata></record> |
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| subjects | Adolescent Adult Aged Child Cholesteatoma, Middle Ear - surgery Clinical Decision-Making Female Head and Neck Surgery Humans Male Medicine Medicine & Public Health Microsurgery - methods Middle Aged Neurosurgery Otologic Surgical Procedures - methods Otology Otorhinolaryngology Retrospective Studies Treatment Outcome Young Adult |
| title | A tailored approach in cholesteatoma surgery |
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