Is cholesteatoma prone to recurrence after surgery? What should I pay attention to after surgery?

Author: Ma Furong, Chief Physician, Peking University Third Hospital

Vice President of the Otolaryngology Branch of the Chinese Medical Doctor Association

Reviewer: Wang Ningyu, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Member of the Otorhinolaryngology and Head and Neck Surgery Committee of the Chinese Medical Association

Cholesteatoma is a benign lesion that often occurs in the middle ear and can cause intracranial and extracranial complications.

Figure 1 Original copyright image, no permission to reprint

Extracranial complications: First, peripheral facial paralysis, which can cause disappearance of forehead wrinkles, inability to close eyes, crooked mouth corners, etc.; second, it can damage the organs of balance, causing labyrinthitis, leading to vertigo and complete hearing loss; third, it can cause damage behind the ears, redness and swelling of the ears, and displacement of the auricle.

If a cholesteatoma in the middle ear or external auditory canal breaks through into the brain, it will cause intracranial complications. First, it will cause meningitis; if it continues to invade, it will cause encephalitis and brain abscesses; if the infection breaks through the blood vessels, it will spread throughout the body through the blood, causing sepsis, septicemia, etc., which can be life-threatening in severe cases.

Therefore, cholesteatoma is like a time bomb, which is very dangerous. Especially for children and young people, once they have cholesteatoma, due to the rapid metabolism, cholesteatoma also develops very quickly, causing more complications. Once discovered, surgery should be performed as soon as possible.

Figure 2 Original copyright image, no permission to reprint

Drugs cannot stop the progression of cholesteatoma, and cholesteatoma grows faster in a humid environment, so it is not recommended for patients with cholesteatoma to always use anti-inflammatory drugs, ear drops, etc.

Conservative treatment is only for very few patients, such as those who have to rely on the only healthy ear to work; or patients who are too old, have serious systemic diseases, and are at risk for general anesthesia surgery; or students who are about to take the college entrance examination and cannot undergo surgery temporarily. If the cholesteatoma can be drained well and the patient can see a doctor at any time, temporary conservative treatment is also possible, and then the best time can be chosen for surgery. If surgery is still not possible, conservative treatment still has risks, and it is necessary to explain it to the family members.

There are no absolute contraindications to surgery for cholesteatoma. The vast majority of patients are suitable for surgical treatment. The earlier the surgery is performed, the more functions can be preserved. Early detection and early surgery are the key to treating cholesteatoma.

1. Can cholesteatoma be completely removed by surgery? Will it recur?

We have now entered the era of ear microsurgery, which can preserve important structures as much as possible while completely removing cholesteatoma. Otherwise, any remaining structure will cause recurrence.

If cholesteatoma recurs, a second surgery is necessary, which is much more difficult than the first surgery. The risk and probability of injury will increase, which will cause many problems and the gains will not outweigh the losses. Therefore, the first surgery must completely remove the cholesteatoma.

The recurrence of cholesteatoma after surgery is related to the doctor's surgical experience and the extent of the patient's lesions. The middle ear cavity is an irregular shape with some dead corners. Any epithelium hidden in the dead corners will lead to recurrence. Therefore, patients who have undergone cholesteatoma surgery should see a doctor once or twice a year, mainly to see if the cholesteatoma has recurred. For patients who have undergone cholesteatoma surgery and whose ear canals are closed, such as cholesteatoma at the petrous apex, magnetic resonance imaging is needed to make a judgment.

Some patients abroad hope to have the eardrum opened a second time six months after surgery to see if the cholesteatoma has recurred. If there is no recurrence, the ossicles will be reconstructed. This staged surgery is not well accepted by Chinese people, who are unwilling to undergo a second surgery, as it may cause some residues and lead to recurrence. Therefore, before cholesteatoma surgery, patients will be informed of the probability of recurrence.

2. What should I pay attention to after cholesteatoma surgery?

After cholesteatoma surgery, you should go to the outpatient clinic for regular checkups and clean the secretions in the ear in time; after the epithelium heals, the scab should also be cleaned regularly; if alcohol is available, the outside of the ear canal can be disinfected; the stitches can usually be removed one week after the surgery, and the dressing can be changed after the ear packing is removed.

Two to three weeks after surgery, you need to massage your ears and pinch your nose to inflate the ears to prevent the eardrum from sticking. Within three months after surgery, it is very important to prevent water from entering the ears and keep the surgical cavity dry to prevent wound infection; do not do things that cause huge changes in ear pressure, such as it is best not to take airplanes, trains, high-speed trains, or dive.

Because of individual differences, lesion range, and surgical cavity size, the length of time for repair is also different. It usually takes one to three months to heal.

After recovery, go to the hospital for a checkup once or twice a year, especially before summer. Ask the otolaryngologist to clean the surgical cavity and drain the cavity to prevent the recurrence of cholesteatoma. At the same time, protect the ears to prevent the cold air from directly stimulating the balance organ. It is recommended to quit smoking, drinking, and eating spicy and irritating foods. Strengthen physical exercise to improve overall immunity. These are very important for preventing the recurrence of cholesteatoma.