Department of Otorhinolaryngology/Head and Neck Surgery, Luzerner Kantonsspital, Spitalstrasse 16, Luzern, 6000, Switzerland.
Eur Arch Otorhinolaryngol. 2024 Oct;281(10):5189-5198. doi: 10.1007/s00405-024-08748-0. Epub 2024 May 29.
In recent years, new techniques have been added to cholesteatoma surgery, and established microsurgical approaches are being reconsidered. This study aims to present the importance of individualized decision-making for the selection of an intact canal wall (CWU) or canal wall down (CWD) surgical procedure for each patient.
Using the "ChOLE" classification we categorized 264 operations retrospectively. 162 CWU and 102 CWD surgeries were performed. We focus to determine why a CWD procedure was chosen quite frequently despite some low-stage cases. Furthermore, we evaluated recidivism and hearing outcomes.
Smaller cholesteatomas (Ch-stage 1a, 1b & 2a) were found in 182 patients (70%), ossicular chain status feasible for straightforward reconstruction (O-stage 0, 1 & 2) was present in 186 patients (70%), minor complications due to the cholesteatoma (L-stage 1) were infrequent with 28 cases (11%) and a well-pneumatized mastoid was found in 144 cases (55%). Recidivism rates were low (7%) without any difference in both groups and a mean follow-up time of 4 years and 8 months. In primary surgeries there was a significant difference (p < 0.05) in postoperative mean air-bone gap (ABG) between CWU (17dB) and CWD (27dB).
The main goals of cholesteatoma surgery remain the avoidance of recidivism and optimal hearing rehabilitation. We recommend a tailored approach in the treatment of cholesteatomas and not a dogmatic one. Surgeons should not hesitate to perform a CWD procedure if required. Performed correctly it results in a dry ear and CWD surgery should remain in the skill set of the otologic surgeon.
近年来，胆脂瘤手术中增加了新技术，并且正在重新考虑已确立的显微外科方法。本研究旨在提出为每位患者选择完整的鼓室壁（CWU）或鼓室壁切开术（CWD）手术的个体化决策的重要性。
使用“ChOLE”分类，我们回顾性地对 264 例手术进行了分类。进行了 162 例 CWU 和 102 例 CWD 手术。我们重点确定为什么尽管存在一些低期病例，但 CWD 手术仍经常被选择。此外，我们评估了复发率和听力结果。
在 182 例患者（70％）中发现较小的胆脂瘤（Ch 期 1a、1b 和 2a），186 例患者（70％）中存在可行直接重建的听骨链状态（O 期 0、1 和 2），28 例患者（11％）中由于胆脂瘤而引起的轻微并发症很少，144 例患者（55％）中发现了充气良好的乳突。复发率较低（7％），两组之间无差异，平均随访时间为 4 年 8 个月。在初次手术中，CWU（17dB）和 CWD（27dB）之间的术后平均气骨导间隙（ABG）存在显著差异（p<0.05）。
胆脂瘤手术的主要目标仍然是避免复发和最佳听力康复。我们建议对胆脂瘤的治疗采用量身定制的方法，而不是教条式的方法。如果需要，外科医生不应犹豫进行 CWD 手术。如果正确执行，它会导致干耳，并且 CWD 手术应保留在耳科外科医生的技能范围内。
