Stadializarea continuă să fie o opţiune rezonabilă în chirurgia colesteatomului

Objectives. To determine whether a separate, staged pro­ce­dure for ossicular chain reconstruction (OCR) re­sults in significantly different hearing results when com­pared to OCR performed concurrent with tympano­mas­toi­dectomy for cholesteatoma. Materials and method. We only included patients undergoing OCR for cholesteatoma within a 5-year period (January 2013 – December 2017). The interventions were OCR concurrent with tympa­no­mas­to­i­dectomy (Group I) or OCR staged following tym­pa­no­mas­toidectomy for cholesteatoma (Group II). The staged procedure was performed within 16 months. The main outcome measures were mean postoperative air-bone gap (ABG) – the mean value, the proportion of pa­tients achieving the ABG closure <20 dB and <30 dB, res­pec­tively – and the way it depended on the type of mas­toid cavity created (open or closed) and on the status of the stapes superstructure (TORP versus PORP). Results. Se­venty-seven patients were included in the study, 34 pa­tients being included in Group I and 43 in Group II. The overall hearing results did not differ significantly in the two groups. When considering the status of the stapes and mas­toid cavity, concurrent OCR resulted in an improved mean postoperative ABG in a closed mastoid cavity with an intact stapes superstructure (P=0.043). Furthermore, a greater proportion of patients who had concurrent OCR within this group achieved ABG <20 dB and ABG <30 dB, alth­ough this difference did not reach a statistical sig­ni­ficance. By contrast, staged OCR resulted in improved mean postoperative ABG in open mastoid cavities with an absent stapes superstructure (P=0.046). A greater proportion also achieved ABG <20 dB and ABG <30 dB, but it was not statistically significant. Conclusions. Staged OCR is preferable in patients with more severe disease, whereas those with a less severe disease may benefit from a con­cur­rent OCR.