Secondary Acquired Cholesteatoma: Presentation and Tympanoplasty Outcomes

Objective: Comparing the clinical features and surgical outcomes of patients undergoing tympanoplasty for secondary acquired cholesteatoma (SAC) versus non-complicated tympanic membrane perforation (TMP). Study Design: Retrospective patient review. Setting: Tertiary-care, academic center. Patients: All 41 patients with diagnosis of SAC confirmed at surgery between January 1, 2007 and June 30, 2014, and an age-matched cohort consisting of patients with TMP. Intervention(s): Tympanoplasty using either medial or lateral graft techniques. Main Outcome Measure(s): Resolution of perforation, SAC, and symptoms. Results: Comparison between the two cohorts failed to reveal significant differences in otologic symptomology, or presentation. There was no significant difference in the resolution of SAC (p = 0.7) between the medial and lateral tympanoplasty techniques. Both techniques also had similar rates of success in the TMP cohort. The medial graft technique was significantly (p = 0.008) more likely to result in a successfully repaired tympanic membrane in the TMP cohort compared with the SAC cohort. The Lateral graft technique demonstrated no significant difference in the likelihood of TMP and SAC resolution. Conclusion: The presentation of SAC is similar to that of TMP despite being a separate clinical entity. A clinician's ability to distinguish the two is important to mitigate the destructive potential of untreated SAC and correctly council patients on tympanoplasty success rates. This study was unable to demonstrate a significant difference in disease control between the medial and lateral tympanoplasty techniques, although potential advantages of each technique are discussed.