Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2025
Is Non-Sac Contained Matrix a Major Predictor for Residual Disease in Acquired Cholesteatoma?
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Luetzenberg Friederike S, Wald James, Chrenka Ella A, Fina Manuela
Аннотация
OBJECTIVE: The objective of this study was to investigate predictive factors for residual disease in acquired cholesteatoma and determine whether the quality of the matrix having a continuous versus disrupted lining-sac versus nonsac contained-impacts the outcomes.
STUDY DESIGN: Retrospective cohort study.
SETTING: Academic teaching hospital.
METHODS: Pediatric and adult EAONO-JOS-staged acquired cholesteatoma operated with endoscopic and combined approaches by the senior author from January 2015 to November 2023 were included. Presence of residual disease was determined through second-look surgery, MRI with DWI, or by clinical examination following canal wall down mastoidectomy. Initial occurrence of residual disease was examined relative to age, sac versus non-sac contained matrix, ossicular status, and surgical approaches using Cox proportional hazard models. Kaplan-Meier curves were used to visualize time to disease stratified by predictive factors.
RESULTS: Out of 105 ears included, 42% had residual disease. In isolation, non-sac contained cholesteatoma (hazard ratio [HR] 3.89, 95% confidence interval [CI] 1.53-9.89), pediatric patients (HR 1.97, 95% CI 1.01-3.85), incus erosion (HR 2.43, 95% CI 1.17-5.05), and stapes erosion (HR 2.01, 95% CI 1.02-4.00) were significantly more likely to develop residual disease. EAONO/JOS stage and surgical approach were not significantly related. In multivariable modeling, only matrix quality retained significance, with non-sac contained matrix associated with a threefold higher hazard of residual disease (HR 3.05, 95% CI 1.17-7.93).
CONCLUSION: When accounting for several factors inherent to the disease process as well as surgical approach, a non-sac contained cholesteatoma matrix was 3 times more likely to lead to residual disease in acquired cholesteatoma among all ages.
STUDY DESIGN: Retrospective cohort study.
SETTING: Academic teaching hospital.
METHODS: Pediatric and adult EAONO-JOS-staged acquired cholesteatoma operated with endoscopic and combined approaches by the senior author from January 2015 to November 2023 were included. Presence of residual disease was determined through second-look surgery, MRI with DWI, or by clinical examination following canal wall down mastoidectomy. Initial occurrence of residual disease was examined relative to age, sac versus non-sac contained matrix, ossicular status, and surgical approaches using Cox proportional hazard models. Kaplan-Meier curves were used to visualize time to disease stratified by predictive factors.
RESULTS: Out of 105 ears included, 42% had residual disease. In isolation, non-sac contained cholesteatoma (hazard ratio [HR] 3.89, 95% confidence interval [CI] 1.53-9.89), pediatric patients (HR 1.97, 95% CI 1.01-3.85), incus erosion (HR 2.43, 95% CI 1.17-5.05), and stapes erosion (HR 2.01, 95% CI 1.02-4.00) were significantly more likely to develop residual disease. EAONO/JOS stage and surgical approach were not significantly related. In multivariable modeling, only matrix quality retained significance, with non-sac contained matrix associated with a threefold higher hazard of residual disease (HR 3.05, 95% CI 1.17-7.93).
CONCLUSION: When accounting for several factors inherent to the disease process as well as surgical approach, a non-sac contained cholesteatoma matrix was 3 times more likely to lead to residual disease in acquired cholesteatoma among all ages.