Clin Exp Otorhinolaryngol.  2014 Dec;7(4):264-268. 10.3342/ceo.2014.7.4.264.

Hearing and Facial Function After Surgical Removal of Cholesteatomas Involving Petrous Bone

• Kim MJ
• An YS
• Jang MS
• Cho YS
• Chung JW

• KMID: 2278365
• DOI: http://doi.org/10.3342/ceo.2014.7.4.264

Abstract

OBJECTIVES
The purpose of this study was to inspect the clinical characteristics, surgical approaches, functional preservation, and complications of petrous bone cholesteatoma and to propose appropriate surgical approaches based on long-term follow-up cases and previous reports in the literature.
METHODS
The medical records of 31 patients who underwent surgery for petrous bone cholesteatoma between 1990 and 2011 at two tertiary referral hospitals were retrospectively analyzed with regard to the classification, type of surgical approach, preservation of facial and auditory function, and recurrence.
RESULTS
Of 31 cases, 16 were supralabyrinthine (class I), 1 was infralabyrinthine-apical (class III), 13 were massive (class IV), and 1 was apical (class V). Facial nerve palsy was found in 35.5% of the cases (11 cases). Hearing was preserved in 11 of 22 patients who had better than a 50-dB hearing level of bone conduction pure tone average preoperatively. Preoperative hearing was preserved in only four of the patients in class I (supralabyrinthine). Facial function was preserved or improved in 29 patients (93.5%).
CONCLUSION
Complete removal of cholesteatoma of petrous bone can be achieved by choosing the appropriate approach based on location and extent. Facial function was preserved postoperatively in most reviewed cases. Auditory function could not be preserved postoperatively in some cases, but preserving residual hearing levels can be accomplished mostly in supralabyrinthine cholesteatomas with the appropriate surgical approach.

Keyword

Petrous bone; Cholesteatoma; Classification; Facial nerve; Hearing

MeSH Terms

Bone Conduction
Cholesteatoma*
Classification
Facial Nerve
Follow-Up Studies
Hearing*
Humans
Medical Records
Paralysis
Petrous Bone*
Recurrence
Retrospective Studies
Tertiary Care Centers

Figure

• 

  Fig. 1 Surgical approaches used to treat 31 petrous bone cholesteatomas classified according to the Sanna classification. TM, tympanomastoidectomy; TLA, translabyrinthine approach; SP, subtotal petrosectomy; TCA, transcochlear approach.

• 

  Fig. 2 Comparison of pre- and postoperative facial nerve function according to the House-Brackmann (H-B) grading system. Facial function was improved postoperatively in 6 cases (*) but worsen in 2 cases.

• 

  Fig. 3 Comparison of pre- and postoperative hearing levels. Hearing was sacrificed in 11 patients who had residual hearing preoperatively. BC, bone conduction.

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