Nonmaleficence in the Management of Giant Cholesteatoma: A Case Series

• Published in: Otolaryngology-head and neck surgery 2014-09, Vol.151 (1_suppl), p.P219-P219
• Main Authors: Kazi, Aasif A., Van Beek-king, Jessica, Solares, C. Arturo, Patel, Sumir S., McKinnon, Brian J.
• Format: Article
• Language: English
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599814541629a258

Objectives: (1) Describe the disease process in giant cholesteatomas, a rare, destructive condition with significant morbidity. (2) Review recent experience in the management and outcomes of giant cholesteatoma. Methods: Retrospective case series at a tertiary hospital-based academic medical referral center from 2004 to 2011. Three patients with giant temporal bone cholesteatoma who were surgically treated were identified. All 3 patients underwent surgical management with wide exteriorization and routine postoperative debridement. Control of disease was measured through recurrence as seen on follow-up. Results: Three adult male patients presented with giant unilateral acquired petrous cholesteatomas over an 8-year period. Two presented with anacusis and facial paralysis, and one with extension of disease to the sphenoid sinus. All were managed with mastoidectomy wide exteriorization; one required an additional staged endoscopic transsphenoidal approach. Hearing and facial function was preserved when present preoperatively. One patient died 5 months postoperatively from H1N1 infection unrelated to his cholesteatoma. Routine postoperative debridement maintained disease control. Follow-up ranged from 5 months to 7 years. Conclusions: Exteriorization of giant petrous cholesteatoma combined with routine postoperative debridement is a safe and effective way of preventing long-term complications and disease recurrence.