ABSTRACT
Aims: The aim of this study is to analyse the clinical data and management of patients with temporal bone carcinoma and to discuss the management outcomes. Study Design: Retrospective study Place and Duration of Study: Universiti Kebangsaan Malaysia Medical Centre (academic tertiary centre) from January 2002 to December 2011. Methodology: Medical records of nine patients were retrieved for this study. There were seven male and two female patients. The mean age of presentation was 60 years old, with an age range between 49 to 75 years. The clinical presentations, investigations, staging, treatment modalities and outcomes are reviewed. Results: Four patients presented with primary tumour of the temporal bone, while the remaining five were referred from other centres with disease recurrence. Only one out of the five patients that were referred to us had underwent a lateral temporal bone resection (LTBR) at presentation which was however an incomplete LTBR. Three out of the five patients (60%) have died with disease recurrence. One patient remained disease free while another patient was lost to follow up. Two out of the four patients who presented with primary tumour remained well while two others had positive margins due to advanced disease at presentation. Conclusion: Recurrence of disease is likely to occur if aggressive treatment is not offered at presentation or if the diagnosis is delayed. We therefore strongly suggest for early referral to a tertiary centre as aggressive primary surgical treatment with adjuvant radiotherapy shows a better prognosis.
ABSTRACT
Introduction: Cholesteatoma is an aggressive disease and its management poses a greater challenge in children than in adults. This study reviews the experience of Universiti Kebangsaan Malaysia Medical Centre in the clinical presentation and management outcome of acquired cholesteatoma in paediatrics that required surgical interventions. Materials and Methods: A retrospective review of case records of patients below 18 years old who underwent surgery from 1999 to 2010. Results: A total of 46 patients presented with 53 cases of cholesteatoma in which seven patients had bilateral disease. The age of presentation ranged from four to 18 years old with a mean age of 12 years. Male and female patients were 65% and 35% respectively. Otorrhoea or previous history of otorrhoea on presentation was found in 94% and 96% of them had hearing impairment. Cerebellopontine angle abscess, sigmoid sinus thrombosis and mastoiditis were among the complications. Tympanic membrane was retracted in 64% while 47% having had attic retraction and 53% had total atelectasis. A majority (85%) underwent canal wall down surgery with or without tympanoplasty. Post-operatively, 71% had improvement or preserved hearing level. The duration of follow up ranged from one month to 13 years and a quarter had recurrent disease and underwent revision surgeries. Conclusion: Majority of the cholesteatoma patients suffered from hearing loss and otorrhoea. Tympanic membrane retraction remained the most common clinical finding. Hence, children with persistent otorrhoea after adequate treatment may represent cholesteatoma. Surgical options of canal wall up and canal wall down procedures have equal risk of recurrence.