Iatrogenic cholesteatoma following tympanoplasty for non-cholesteatomatous chronic otitis media

ABSTRACT

Iatrogenic cholesteatoma is a form of recidivism that results from squamous epithelial seeding or entrapment as a result of the surgical. They may occur after tympanoplasty, whether or not cholesteatoma was originally present. Incidence of iatrogenic cholesteatoma resulting from ear surgery for non cholesteatomatous otitis media is around 5%. In this retrospective study we describe the site of origin and time of occurrence of iatrogenic epidermoid cysts or cholesteatoma following a series of cases that underwent tympanoplasty for CSOM without cholesteatoma by the author at the Ear Nose and Throat Teaching Hospital. The significance of this information is to help us predict the type character, site and postoperative time of appearance of iatrogenic cbolesteatoma. Managed in the right time, this step is hoped to prevent the development of a more extensive disease and thus reduce the incidence of recurrent active cholesteatoma. A series of 180 tympanoplasties with or without Mastoidectomy, for COM without cholesteatoma were included. Eight cases of iatrogenic cholesteatoma [4.4%] were identified in the form of epidermoid cysts [pearls] [n=8] or frank open cholesteatoma [n=2]. Postoperative time of detection was 4-12 months for the pearls and 4 and 5 years for the open cholesteatoma Site of recurrence for pearls were mainly related to the annulus and the handle of the malleus. While cholesteatoma of the open type originated in the posterior bony wall of the external auditory canal eroding the bone and invading the mastoid where they extended to the antrum and attic. Suggestions for prevention early detection and management of these recurrences are presented