Predictors of hearing improvement in patients with middle ear cholesteatoma

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BACKGROUND: The primary goal of middle ear cholesteatoma (MEC) surgery is to totally eradicate the pathology and at the least to preserve hearing at preoperative levels or improve it. In 2017, the European Academy of Otology and Neurotology/Japanese Otological Society (EAONO/JOS) published a new cholesteatoma staging system. This prospective study analyzed the surgical outcomes of patients and evaluated the clinical outcomes and factors predicting hearing improvement.

MATERIALS AND METHODS: A prospective cohort study included 175 patients (178 ears) who had undergone MEC surgery between 2016 and 2020. Based on presurgical computed tomography of the temporal bone and surgical protocols, the disease was staged according to the EAONO/JOS staging system. The results obtained by pre- and postoperative pure tone audiometry were analyzed according to the surgical technique used and disease stage. Several potential prognostic factors were evaluated: type of surgical technique, state of the ossicular chain, prosthesis type, and process extension.

RESULTS: Significant hearing improvement was noted after 1 and 3 years in patients with preserved stapes superstructure (p < 0.001 and p = 0.019, respectively) and after 1 year in patients who underwent surgery with intact canal wall (p = 0.001). The influence of the process extension (stages according to EAONO/JOS staging system) on the long-term functional outcome after 1 and 3 years was revealed (p = 0.007 and p = 0.005).

CONCLUSIONS: Low-grade EAONO/JOS stage, preservation of the stapes superstructure, and type of surgery (canal wall-up mastoidectomy) are predictors of successful postoperative functional outcomes.

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Sobre autores

Olga Tarasova

Russian Medical Academy of Continuous Professional Education

Email: olya.tar@inbox.ru
ORCID ID: 0000-0002-6986-9260
Código SPIN: 7867-8350

Postgraduate student

Rússia, Moscow

Sergey Kosyakov

Russian Medical Academy of Continuous Professional Education

Autor responsável pela correspondência
Email: Serkosykov@yandex.ru
ORCID ID: 0000-0001-7242-2593
Código SPIN: 9349-4250

MD, Dr. Sci. (Medicine), Professor

Rússia, Moscow

Bibliografia

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2. Fig. 1. Incus autoprosthesis insertion: (a) before insertion (the arrow indicates the head of the stapes) and (b) the prosthesis inserted on the head of the stapes (the arrow indicates the autoprosthesis)

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3. Fig. 2. Titanium Kurz partial ossicular replacement prosthesis (indicated by the arrow) placed on the head of the stapes

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4. Fig. 3. Frequency of hearing improvement (%) 1 year after the surgery according to the stage of middle ear cholesteatoma (p = 0.007). ABG, air–bone gap

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5. Fig. 4. Patient distribution by surgical technique (%) (stage I of the EAONO/JOS staging system) in the research and control groups. EAC, external auditory canal

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