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Hearing and ossicular chain preservation in cholesteatoma surgery

Published online by Cambridge University Press:  18 October 2010

R Obholzer ,
J Ahmed ,
F Warburton  and
M J Wareing
R Obholzer*
Affiliation:
Department of Otolaryngology Head and Neck Surgery, St Bartholomew's and the Royal London Hospital, London, UK
J Ahmed
Affiliation:
Department of Otolaryngology Head and Neck Surgery, St Bartholomew's and the Royal London Hospital, London, UK
F Warburton
Affiliation:
Joint Research and Development Office, St Bartholomew's and the Royal London Hospital, London, UK
M J Wareing
Affiliation:
Department of Otolaryngology Head and Neck Surgery, St Bartholomew's and the Royal London Hospital, London, UK
*
Address for correspondence: Mr Rupert Obholzer, 5 Little Saint Leonards, London SW14 7LT, UK Fax: (+44) (0)207 188 2206 E-mail: rupertobholzer@gmail.com
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Abstract

Objective:

To assess the hearing changes associated with sacrificing an intact ossicular chain during cholesteatoma surgery.

Methods:

We reviewed the operation notes of surgical procedures performed by the senior author between October 2000 and April 2006. Thirty-three cases were identified in which cholesteatoma surgery had been performed in the presence of a mobile, intact ossicular chain. One set of case notes was missing; therefore, 32 cases were included in the analysis. The ossicular chain was preserved in 17 cases (14 males and three females) and sacrificed in 15 (eight males and seven females).

Results:

At the first post-operative assessment, a median air–bone gap deterioration of 3.3 dB was seen in patients in whom the ossicular chain had been sacrificed, while a median air–bone gap improvement of 3.3 dB was seen in those in whom the chain had been preserved. However, multivariable logistic regression analysis suggested that this difference in hearing outcomes was due to pre-operative hearing status, and that preservation of the ossicular chain did not lead to a better outcome.

Conclusions:

In cholesteatoma surgery, there is at most a marginal benefit in preserving the ossicular chain. In the current study, the better hearing outcomes associated with preservation of the ossicular chain were accounted for by patients' better pre-operative hearing status. This study did not demonstrate a difference in residual disease rate, but was underpowered to do so.

Keywords

CholesteatomaHearingTympanoplastyOtologic Surgical Procedures
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 125 , Issue 2 , February 2011 , pp. 147 - 152
Copyright
Copyright © JLO (1984) Limited 2010

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