Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan, Malaysia, Kuala Lumpur.
Department of Radiology, Faculty of Medicine, Universiti Kebangsaan, Malaysia, Kuala Lumpur.
Int Tinnitus J. 2024 Mar 21;27(2):242-246. doi: 10.5935/0946-5448.20230037.
A cholesteatoma is an expansion of keratinizing squamous epithelium that enters the middle ear cleft from the outer layer of the tympanic membrane or ear canal. Choleatomas are always treated surgically. Recurrence of the illness presents another challenge for the patient and the surgeon, though. There have been reports of recurrence rates as high as 30% in adults and as high as 70% in children. Here, we describe a case of persistent recurrent otorrhea following revision surgery, along with acquired recurrent cholesteatoma following canal wall down surgery. A 38-year -male with underlying Diabetes Mellitus and Hypertension presented with left scanty and foul-smelling ear discharge for 2 years and left reduced hearing. He was diagnosed with left chronic active otitis media with cholesteatoma for which he underwent left modified radical mastoidectomy, meatoplasty and tympanoplasty in 2017. Five months post operatively, he presented with left otorrhea. However, he defaulted followed up and presented in April 2018 for similar complaints. Otoscopy examination revealed left tympanic membrane perforation at poster superior quadrant of pars tensa and bluish discoloration behind pars flacida. He was diagnosed as recurrent left cholesteatoma and subsequently he underwent left mastoid exploration under general anesthesia in June 2018. Postsurgery, he developed recurrent ear discharge which was treated with topical antibiotics and ear toileting. We report a case of recurrent Cholesteatoma despite canal wall down procedure requiring a second redo procedure and with persistent recurrent otorrhea after the redo procedure.However, this case demonstrates the need for regular follow ups even after a canal wall down procedure for detecting recurrence of disease. Moreover, this case denotes some of the patient factors and surgeon factors involved in disease recurrence. Furthermore, importance of opting for an imaging study in case of high suspicion of the disease.
胆脂瘤是一种角化鳞状上皮从鼓膜或外耳道的外层向内耳中耳裂隙扩张。胆脂瘤总是需要手术治疗。然而，疾病的复发对患者和外科医生来说是另一个挑战。有报道称，成人复发率高达 30%，儿童高达 70%。在这里，我们描述了一例经修正手术后持续性复发性耳漏，以及经耳道下壁手术后获得性复发性胆脂瘤。一名 38 岁男性，患有糖尿病和高血压，左耳有少量恶臭耳漏 2 年，左耳听力下降。他被诊断为左慢性活动性中耳炎伴胆脂瘤，2017 年接受了左改良根治性乳突切除术、耳成形术和鼓室成形术。术后 5 个月，他出现左耳漏。然而，他没有随访，于 2018 年 4 月因类似症状就诊。耳镜检查显示左耳鼓膜紧张部后上象限穿孔，松弛部后蓝染。他被诊断为左复发性胆脂瘤，随后于 2018 年 6 月在全身麻醉下接受了左乳突探查术。手术后，他出现复发性耳漏，经局部抗生素和耳部清洗治疗。我们报告了一例胆脂瘤复发病例，尽管进行了耳道下壁手术，但仍需进行第二次翻修手术，且在翻修手术后仍持续出现耳漏。然而，这个病例表明，即使进行了耳道下壁手术，也需要定期随访，以发现疾病的复发。此外，这个病例还涉及到一些与疾病复发有关的患者因素和外科医生因素。此外，在高度怀疑疾病的情况下，选择影像学检查的重要性。
