From the Guidelines
The treatment for a cholesteatoma typically involves surgical removal by an otolaryngologist for definitive management. When considering the management of cholesteatoma, it's crucial to prioritize the most effective approach to prevent morbidity, mortality, and improve quality of life. The primary surgical approach is a mastoidectomy, which may be either a canal wall up (CWU) or canal wall down (CWD) procedure depending on the extent of the disease 1. Before surgery, antibiotics may be prescribed to control infection and reduce inflammation, commonly including topical antibiotic drops containing fluoroquinolones or aminoglycosides. Key considerations in the treatment of cholesteatoma include:
- Complete removal of the cholesteatoma to prevent recurrence
- Repair of any damage to surrounding structures
- Prevention of potential complications such as hearing loss, facial paralysis, meningitis, or brain abscess Following surgery, patients require regular follow-up appointments for several years to monitor for recurrence, which happens in about 20-30% of cases. Given the potential for serious complications if left untreated, surgical removal of the cholesteatoma is the recommended treatment approach. It's essential to refer any patient with suspected cholesteatoma to an otolaryngologist for definitive management, as emphasized in the clinical practice guideline for acute otitis externa 1.
From the Research
Treatment for Cholesteatoma
- The primary treatment for cholesteatoma is surgical, with the aim of providing a disease-free, dry ear and, if possible, improving hearing function 2.
- Surgical approaches to cholesteatoma include various techniques such as canal wall up or canal wall down mastoidectomy, with or without mastoid obliteration 3, 4.
- The choice of surgical technique may influence hearing outcomes, with some studies suggesting that reconstructive surgical techniques, such as tympanoplasty with two-stage canal wall up mastoidectomy, may result in better hearing outcomes 5.
- Antibiotic treatment may also be used in conjunction with surgery to reduce the risk of infection, with protocols varying depending on the presence of preoperative otorrhea and other factors 6.
Surgical Techniques
- Canal wall down (CWD) mastoidectomy with mastoid obliteration (MO) has been shown to be associated with lower recurrence rates and improved control of otorrhea compared to CWD without MO or canal wall up (CWU) mastoidectomy 4.
- Tympanoplasty with two-stage canal wall up mastoidectomy has been shown to result in improved hearing outcomes, including better air-bone pure tone average (PTA) and mean differential auditory threshold, compared to CWU mastoidectomy 5.
Postoperative Care
- Antibiotic treatment may be continued postoperatively to reduce the risk of infection, with the specific protocol depending on the surgical technique and individual patient factors 6.
- Follow-up care is important to monitor for signs of recurrence or complications, and to assess hearing outcomes and overall patient recovery 2, 5.