Chronic Draining Ear and Cholesteatoma Recidivism: A Retrospection from Clinical, Imaging, and Surgical Perspectives

Özet

Objective: To evaluate the reasons for persistentdraining ear and cholesteatoma recidivism followingcanal wall down (CWD) tympanomastoidectomy bystudying the sensitivity of high-resolution computedtomography (HRCT) scanning in different potentialetiologies, corroborating through appropriate surgicalintervention, and thereby, to suggest proper preventive measures.Methods: In this observational study, 32 chronic,refractory draining ears were subjected to revisionsurgery following a radical or a modified radical mastoidectomy. Besides disease (cholesteatoma/granulations) eradication, pitfalls of the primary surgerieswere addressed. Data were interpreted for studyingthe epidemiologic profile, the clinical presentation atrecurrence, the type of primary surgery, the sites ofrecidivism, the probable causes, and the best possiblemanagement at revision.Results: Of the 32 patients/ears, 23 had residual/recurrent cholesteatoma. Major reasons were inadequate disease clearance, contracted/inadequate conchomeatoplasty, no cavity obliteration, and inappropriate bone work. HRCT predicted persistent bridgeand lateral semicircular canal dehiscence with 100%,and ossicular integrity and bony overhang with >80%sensitivity. Sinus tympani and oval window nichewere the commonest sites of recurrence. At revision,radical/modified radical mastoidectomies were associated with cavity obliteration and appropriate revision of conchomeatoplasty in 28 patients.Conclusion: Recurrence of cholesteatoma/granulations is an important cause for chronic drainagefrom post-CWD cavities. Revision surgery exploresthe surgical pitfalls, and ensures clearance of diseasefrom hidden areas, adequate bone work, and optimumconchomeatoplasty following cavity obliteration toprovide a safe, dry ear with hearing improvementwhenever feasible.