Endoscope-Assisted Surgery for Petrous Bone Cholesteatoma with Hearing Preservation

Orhan, Kadir Serkan; Çelık, Mehmet; Polat, Beldan; Aydemir, Levent; Aydöseli, Aydın; Sencer, Altay; Güldíken, Yahya

doi:10.5152/iao.2019.7212

Cited by 9 publications

(7 citation statements)

References 19 publications

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“…A review of the literature yielded five articles that met inclusion criteria,[ 12 , 22 , 26 , 37 , 38 ] four of which were case reports and one a retrospective cohort study. There were eight pediatric patients (63% males) with cholesteatomas of the petrous apex that was surgically removed in nine total ears within this systematic review.…”

Section: Resultsmentioning

confidence: 99%

“…As epidermoid cysts of the petrous portion of the temporal bone, congenital petrous bone cholesteatomas may initially be asymptomatic if they extend in the direction of the nonpetrous portion of the temporal bone, leaving the tympanic membrane unscathed. [ 26 ] Alternatively, physical examination may reveal purulent otorrhea in the affected ear. Due to their proximity to and potential involvement of the cochleovestibular labyrinth, otic capsule, facial nerve, and dura mater of the meninges, cholesteatomas often manifest with hearing loss, headache, dizziness, otorrhea, and facial paralysis.…”

Section: Discussionmentioning

confidence: 99%

“…Due to their proximity to and potential involvement of the cochleovestibular labyrinth, otic capsule, facial nerve, and dura mater of the meninges, cholesteatomas often manifest with hearing loss, headache, dizziness, otorrhea, and facial paralysis. [ 26 ] Deteriorations in conductive hearing and facial nerve function will generally occur gradually. [ 22 ] Interestingly, in the case described by MacKeith et al ., the patient presented with recurrent aseptic meningitis as a result of a congenital petrous apex cholesteatoma.…”

Section: Discussionmentioning

confidence: 99%

“…For example, in their retrospective case series of eight patients, Orhan et al reported that of eight patients who underwent endoscope-assisted surgery for petrous bone cholesteatoma, four exhibited normalrange hearing on preoperative PTA. [26] is is not surprising, because children with petrous bone cholesteatomas normally present with fewer symptoms than adults who develop the lesion. [37] In fact, the literature indicates that pediatric congenital cholesteatomas can spare auditory and facial nerve function even when they invade the petrous bone.…”

Section: Symptomatologymentioning

confidence: 99%

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Surgical management of petrous apex cholesteatomas in the pediatric population: A systematic review

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Elston

et al. 2022

Surgical Neurology International

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Background: Cholesteatomas are growths of squamous epithelium that can form inside the middle ear and mastoid cavity and damage nearby structures causing hearing loss when located at the petrous apex. The primary goal of petrous apex cholesteatoma resection is gross total removal with tympanoplasty and canal-wall up or canal-wall down tympanomastoidectomy. At present, there is no definitive surgical approach supported by greater than level 4 evidence in the literature to date. Methods: A systematic review was conducted utilizing PubMed, Embase, and Scopus databases. Articles were screened and selected to be reviewed in full text. The articles that met inclusion criteria were reviewed for relevant data. Data analysis, means, and standard deviations were calculated using Microsoft Excel. Results: After screening, five articles were included in the systematic review. There were a total of eight pediatric patients with nine total cholesteatomas removed. Conductive hearing loss was the most common (77%) presenting symptom. Perforations were noted in seven ears (86%). Recurrence was noted in 50% of patients with an average recurrence rate of 3.5 years (SD = 1.73). Average length of follow-up was 32.6 months (SD = 21.7). Canal-wall up was the most utilized technique (60%) and there were zero noted surgical complications. Five of the seven (71%) patients that experienced hearing loss from perforation noted improved hearing. Conclusion: Due to its rarity, diagnostic evaluation and treatment can vary. Further, multi-institutional investigation is necessary to develop population-level management protocols for pediatric patients affected by petrous apex cholesteatomas.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Symptomatologymentioning

confidence: 99%

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Surgical management of petrous apex cholesteatomas in the pediatric population: A systematic review

Reardon

Turnow

Elston

et al. 2022

Surgical Neurology International

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“…The endoscopic surgical technique is a recent source of debate due to its increased use in association with microsurgery. According to Orhan et al, 23 the association with an angled endoscope avoids invasive techniques (es: middle fossa) better visualizing the hidden area of the temporal bone and allowing a more radical removal of the cholesteatoma matrix, while reducing the incidence of disease recurrence.…”

Section: Discussionmentioning

confidence: 99%

Petrous Bone Cholesteatoma: Facial and Hearing Preservation

et al. 2021

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Objectives: Petrous bone cholesteatoma (PBC) is a rare condition of the petrous portion of the temporal bone. Treatment of choice consists of radical surgical removal, paying attention to protect the facial nerve and inner ear as far as possible. The aim of the present study was to evaluate the efficacy of modified translabyrinthine techniques in preserving hearing function and the use of the adjuvant endoscopic techniques in a group of PBC patients. Methods: This study comprised 16 cases of PBCs surgically treated in our Department. Pre- and post-operative hearing status was assessed with pure tone audiometry and speech discrimination and graded according to the Gardner- Robertson classification system. Facial function was based on the House Brackman (HB) classification. PBCs were grouped using Sanna’s classification. The choice of surgical technique was based on the above findings together with preoperative evidence. Post-operative follow-up ranged from 1 to 10 years and also included Computed Tomography and Magnetic Resonance Imaging assessment. Results: PBCs were classified as follows: 37.5% infralabyrinthine; 43.75% supralabyrinthine; and 18.75% massive. Preservation of the bone conduction threshold was feasible in 62.5% of patients. For supralabyrinthine PBCs a subtotal petrosetomy was performed in all cases and hearing preservation was possible in 57% of them: an adjuvant endoscopic approach was performed in 43%. Infralabyrinthine PBCs were treated using a modified translabyrinthine approach with preservation of bone conduction in 83% of patients; an adjuvant endoscopic approach was performed in 50% cases. One patient with a massive cholesteatoma was treated by modified translabyrinthine approach, preserving a serviceable level of hearing. In all massive cases, an adjuvant endoscopic approach was performed. In 2 patients with preoperative palsy, facial nerve function showed an improvement. The follow-up period revealed evidence of limited recurrence at CT imaging in 2 patients. Conclusions: The introduction of modified surgical approaches, able to preserve the anatomical-functional structures, have shown an improvement of post-operative hearing outcomes.

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