Clinical and Surgical Features of Acquired Middle Ear Cholesteatoma: A 10 Years Population-based Study

Background: Cholesteatomas are benign destructive lesions of the temporal bone that may lead to life-threatening complications. Objectives: This study described the clinical and surgical characteristics of chronic otitis media patients with acquired middle ear cholesteatoma. Methods: Among 1790 patients with chronic otitis media detected during almost 10 years, 449 suffered from cholesteatoma. The clinical features and surgical data were investigated. Results: Among the chronic otitis media patients, 449 (25.0%) cases had cholesteatoma with a mean age of 32.2 ± 16.1 SD years, and 62.8% were male. The most common symptom was otorrhoea (53%), followed by hearing impairment (37.9%). Erosion of the facial nerve canal was observed in 33.1% of patients, dural plate erosion in 4.8% of cases, and labyrinthine fistula in 10.3% of patients. Moreover, ossicular chain erosion was observed with the highest frequency in incus (40%), followed by malleus (33%) and stapes (26%). Amongst the surgically treated patients, 59.3% underwent mastoidectomy with canal wall preservation, 29.7% underwent modified radical mastoidectomy, and radical mastoidectomy was performed in 11% of patients. Conclusions: Cholesteatoma was seen in about a quarter of patients with chronic otitis media. Based on our findings, cholesteatoma can be associated with serious complications such as facial nerve canal erosion (33.1%), dural plate erosion (4.8%), and labyrinthine fistula (10.3%). Regarding the functional importance of the hearing system and the high prevalence of disease complications, middle ear cholesteatoma needs long-term follow-up.