Time Management of Recurrent Cholesteatoma Following Open Mastoidectomy: A Suggested Follow-up Schedule

Recurrent cholesteatoma is a serious complication due to its insidious, progressive and destructive nature. It should be detected and managed as early as possible. Jn a previous study we retrospectively reviewed the files of a series of 42 cases of cholesteatoma that underwent open mastoidectomy techniques (modified radical mastoidectomies and atticotomies) by the author at the Hearing and Speech Institute in Egypt. We identified the incidence, clinical findings, types and characteristics of recurrent cholesteatoma by regular long term follow-up. There were two main types of recurrence; the open (or flat) type with the clinical picture of active cholesteatoma with an incidence of 9.5% with average time of onset of 4 months postoperative, and the closed silent epidermoid cyst (or pearl) in an otherwise healthy mastoid/ middle ear cavity (24%) with average onset of 11 months postoperative. Both types presented in the same ear in two cases (4.7%), and were termed the mixed type. All pearls were successfully removed per-meatal as an out-patient procedure with minima] morbidity and mostly under local anesthesia. While all recurrence of the open type required revision surgical exploration under general anesthesia. The aim of present study is to use the above information to design a follow up time schedule that will enable the timely detection and removal of recurrence at an early stage and reduce the incidence of late recurrence that will require revision surgery. Conclusion: A suggested follow-up schedule was designed. The most important aspect of which is the scrutiny of examination at one year postoperative to detect hidden pearls which formed the majority of recurrent cases. Early removal of these pearls is believed to markedly reduce the incidence of recurrent active cholesteatoma that will require revision surgery.