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Inicio Acta Otorrinolaringológica Española Cholesteatoma: Influence of surgical technique and EAONO/JOS stage on audiologic...
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Vol. 73. Issue 3.
Pages 184-190 (May - June 2022)
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Vol. 73. Issue 3.
Pages 184-190 (May - June 2022)
Original article
Cholesteatoma: Influence of surgical technique and EAONO/JOS stage on audiological results
Colesteatoma: influencia de la técnica quirúrgica y el estadio EAONO/JOS en los resultados audiológicos
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Josefa Olmedo Martínez
Corresponding author
pepaolmmar@gmail.com

Corresponding author.
, Francisco Ropero Romero, Serafín Sánchez Gómez
Hospital Universitario Virgen Macarena, Sevilla, Spain
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Tables (5)
Table 1. EAONO/JOS classification for cholesteatoma.
Table 2. Classification of hearing level according to the Bureau International d’Audiophologie.
Table 3. Distribution of patients according to surgical technique and EAONO/JOS classification.
Table 4. Mean values of study variables grouped by surgical technique (mean, standard deviation and significance of comparisons).
Table 5. Mean values of the study variables grouped according to EAONO/JOS stage (mean, standard deviation and significance of comparisons).
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Abstract
Introduction and objective

The treatment of cholesteatoma is surgical in most cases. When it is indicated, it is preferable to choose a reconstructive surgical technique with the dual purpose of eradicating the disease and preserving or improving the patient’s hearing. In 2017, the European Academy of Otology and Neuro-Otology/Japanese Otological Society (EAONO/JOS) published a new cholesteatoma classification. The aims of this study were to determine the influence of the surgical technique used and this classification on patient’s hearing outcomes.

Methods

A retrospective study that included patients who underwent reconstructive surgery of cholesteatoma between 2012 and 2017 was carried out. Based on pre-surgical computed tomography (CT) images, disease was staged according to the EAONO/JOS classification. Hearing outcomes obtained by pre and postoperative pure tone audiometry were analysed according to the surgical technique used and according to the stage of the disease.

Results

143 patients with no statistically significant differences in hearing thresholds before surgery were included. One year after surgery, all the patients’ (P = .01 and P = .001) airpure tone average (PTA) and mean differential auditory threshold had improved significantly. Those patients who underwent tympanoplasty with two-stage canal wall up mastoidectomy presented better postsurgical air PTA and postsurgical mean differential auditory threshold outcomes (P = .007 and P = .014) than those patients who underwent tympanoplasty with canal wall down mastoidectomy. Moreover, the patients who underwent tympanoplasty with two-stage canal wall up mastoidectomy had improved air PTA and mean differential auditory threshold one year after the surgery with statistical significance (P = .001, P = .013). The mean differential auditory threshold was also better (P = .008) in the patients who underwent tympanoplasty with canal wall down mastoidectomy one year after the procedure.

Conclusions

Reconstructive surgical techniques improve hearing one year after surgery. In our study, this improvement was significantly greater with tympanoplasty with two-stage canal wall up mastoidectomy.

Keywords:
Cholesteatoma
Classification
Hearing outcomes
Tympanoplasty with canal wall down mastoidectomy
Tympanoplasty with canal wall up mastoidectomy
Resumen
Antecedentes y objetivo

El tratamiento del colesteatoma es quirúrgico en la mayoría de los casos. Cuando está indicado, es preferible optar por una técnica quirúrgica reconstructiva con el doble propósito de eliminar la enfermedad y preservar o mejorar la audición del paciente. En 2017 se ha publicado una nueva clasificación del colesteatoma por parte de la European Academy of Otology and Neuro-Otology/Japanese Otological Society (EAONO/JOS). El objetivo de este estudio es determinar la influencia que tanto la técnica quirúrgica empleada como la clasificación de la enfermedad tienen en los resultados auditivos de los pacientes.

Materiales y métodos

Se realiza un estudio retrospectivo que incluye pacientes intervenidos de colesteatoma mediante una técnica reconstructiva entre 2012 y 2017. A partir del TC prequirúrgico de cada paciente se estadifica la enfermedad según la clasificación de la EAONO/JOS. Los datos audiológicos obtenidos mediante audiometría tonal liminar (ATL) pre y postoperatoria son analizados en función de la técnica quirúrgica empleada y según el estadio de la enfermedad.

Resultados

Se incluyen 143 pacientes con umbrales auditivos sin diferencias significativas antes de la cirugía. Al año de la intervención, el Umbral Medio Auditivo (PTA, de sus siglas en inglés Pure Tone Average) aéreo y el umbral diferencial auditivo (UDA) medio mejoran significativamente (p = 0,01 y p = 0,001) en toda la muestra. Los pacientes intervenidos con técnica cerrada en dos tiempos presentan mejores resultados en el PTA aéreo postoperatorio y UDA medio postquirúrgico que los operados mediante técnica abierta (p = 0,007 y p = 0,014). El PTA aéreo postoperatorio y el UDA medio postoperatorio mejoran en los pacientes intervenidos con técnica cerrada en dos tiempos quirúrgicos (p = 0,001, p = 0,013), en comparación con la audición previa que presentaban. El UDA medio postoperatorio también mejora significativamente en los pacientes operados mediante técnica abierta (p = 0,008).

Conclusiones

Todas las técnicas quirúrgicas reconstructivas producen una mejora significativa de la audición al año de la intervención. En nuestro estudio esta mejora es significativamente superior con una timpanoplastia con mastoidectomía cerrada en dos tiempos quirúrgicos.

Palabras clave:
Colesteatoma
Clasificación
Resultados audiológicos
Timpanoplastia con mastoidectomía abierta
Timpanoplastia con mastoidectomía cerrada

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