PREVENTION OF CHOLESTEATOMA AND RELATED COMPLICATIONS

Gordon B. Hughes, M.D., F.A.C.S Cleveland Clinic Foundation Cleveland, Ohio, U.S.A.

TYPES OF CHOLESTEATOMA
Congenital (embryonic rest) Acquired (before surgery) Recurrent (after surgery)

Prevention of Complications of Congenital Cholesteatoma

The only prevention is early detection and surgery

Photography by Eiji Yanagisawa, M.D.

PATHOGENESIS
Chronic eustachian tube dysfunction Atrophic TM and retraction Ingrowth of squamous epithelium Squamous metaplasia Trapped epithelium/basal cell proliferation Iatrogenic causes

SEROUS OTITIS MEDIA

Photography by Eiji Yanagisawa, M.D.

RETRACTION POCKET

Photography by Eiji Yanagisawa, M.D.

ADHESIVE OTITIS

Photography by Eiji Yanagisawa, M.D.

ACQUIRED CHOLESTEATOMA

Photography by Eiji Yanagisawa, M.D.

Prevention of Acquired Cholesteatoma

PE tubes Antibiotics Adenoids Allergy Surgery

Photography by Eiji Yanagisawa, M.D.

RECURRENT POSTOPERATIVE CHOLESTEATOMA

Residual disease: original disease left intentionally or unintentionally in the middle ear at time of surgery Recurrent disease: forms in a postoperative retraction pocket

PREVENTION OF POSTOPERATIVE CHOLESTEATOMA

Judicious, aggressive surgery Second-look surgery Obliterate/support attic defect Canal wall-down mastoidectomy