[Comparison of clinical features of facial paralysis secondary to petrous bone cholesteatoma and middle ear cholesteatoma].

The article aimed to explore the differences in clinical features of facial paralysis secondary to petrous bone cholesteatoma and middle ear cholesteatoma. The clinical data of 156 patients (156 ears) aged (37.9±16.3) years with petrous apex cholesteatoma or middle ear cholesteatoma at the Eye & ENT Hospital of Fudan University from December 2014 to December 2024 were retrospectively collected, with 97 males and 59 females. There were 101 and 55 cases diagnosed with petrous apex cholesteatoma and middle ear cholesteatoma, respectively. The proportion of cases with facial paralysis as the initial symptom in petrous apex cholesteatoma [42.6% (43/101)] was statistically significantly higher than that of middle ear cholesteatoma [18.2% (10/55)] (P=0.002). The proportion of facial paralysis duration to the total disease course was significantly higher in petrous apex cholesteatoma [M (Q1, Q3)] [20.0% (0, 100%)] compared with middle ear cholesteatoma [0.4% (0, 23.3%)] (P=0.003). The main injury sites of facial nerve canal observed in patients of petrous apex cholesteatoma during surgery were the labyrinthine segment (58 ears, 57.4%), the geniculate ganglion (61 ears, 60.4%) and the tympanic segment (65 ears, 64.4%), while the tympanic segment (43 ears, 78.2%) was the most observed injury site in middle ear cholesteatoma, with a statistically significant difference between the two groups (P<0.001). The common lesion type of facial nerve seen in the surgery was compression (50 ears, 49.5%) inpetrous apex cholesteatoma and bareness (21 ears, 38.2%) in middle ear cholesteatoma, with a statistically significant difference between the two groups (P<0.001). The current study suggests that compared with middle ear cholesteatoma, petrous apex cholesteatoma, due to its deep location and insidious symptoms, often induces more severe damage to the facial nerve by the time of diagnosis.