Time Analysis of Recidivism in Acquired Cholesteatoma Using the Kaplan-Meier Method

Abstract

Objective:To analyze the time trends of recidivism of acquired cholesteatoma using the Kaplan-Meier method. Study Design: We conducted a retrospective, observational study of 256 patients having their first cholesteatoma surgery. The cumulative recidivism-free rate was calculated using Kaplan-Meier survival analysis related to the follow-up period, pathophysiology, the extent of the disease, and recidivism pathologies. Results: Pars flacida cholesteatoma with tympanic cavity progression had a high likelihood of recurrence disease. Pars tensa cholesteatoma led to more recurrence of the disease than the residual disease. In both pars flacida and pars tensa cholesteatoma, the incidence of disease recurrence increased even 3 years after surgery. On the contrary, the incidence of residual disease peaked within 3 years after surgery, and thereafter, the incidence of residual disease tended to be small. In particular, pars flacida cholesteatoma extending into the mastoid cavity or tympanic cavity tended to recur up to 5 years postoperatively. Conclusions: We calculated the cumulative recidivism-free rates of 256 patients with cholesteatoma using Kaplan-Meier survival analysis. These results can lead to better estimates of the length of the follow-up period. Level of Evidence: Level IV evidence from case-control studies.

Augmented Reality-Assisted Transcanal Endoscopic Ear Surgery for Middle Ear Cholesteatoma

“…The main goal in the treatment of cholesteatoma is to reduce the recurrence rate. Although residual disease has been shown to decrease with the use of endoscopes [ 40 ], recurrent disease remains a problem [ 2 , 3 , 4 , 5 ]. Thus, the idea of more reliable reconstruction is certainly an important strategy.…”

“…Cholesteatomas are benign collections of keratinized squamous epithelium, mostly found within the middle ear; however, they are an intractable chronic proliferative disease that can cause fatal complications, such as bone destruction and brain abscesses. The only treatment option is surgery, and the long-term recurrence rate is reported to be as high as approximately 20–60% [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. Recurrence rates vary widely depending on the method of statistical analysis and period of observation, making it difficult to determine the optimal strategy for selecting a procedure.…”

Cholesteatoma Severity Determines the Risk of Recurrent Paediatric Cholesteatoma More Than the Surgical Approach

“…Sub-division of Stage 2 has been suggested, for example, by ossicular status or the presence/absence of mastoid extension [14,33]. The extension of pars flaccida cholesteatoma into the mastoid has been shown to increase the risk of recurrence [15]. In this series, the division of Stage 2 into those with and without mastoid cholesteatoma split the group into equal-sized halves and demonstrated a significantly higher rate of recurrent cholesteatoma for those that had extended into the mastoid, showing that this modification may provide greater utility to the staging system.…”

“…Staging was applied prospectively after publication of the classification in 2017 but retrospectively to earlier data as described previously [14]. To compensate for a preponderance of cases in Stage 2, this group was divided according to whether cholesteatoma extended into the mastoid or not, also as proposed previously [14,15]. Type of surgery was categorised into three types according to presumed effect on mastoid physiology.…”