Luiza Alexi Freitas

Characteristics of 419 patients with acquired middle ear cholesteatoma.

INTRODUCTION Cholesteatoma is a destructive lesion that can result in life-threatening complications. Typically, it presents with hypoacusis and continuous otorrhea as symptoms. Because it is a rare disease, there are few studies in Brazil describing the characteristics of patients with the disease. OBJECTIVE This study aimed to determine the prevalence of cholesteatoma in patients with chronic otitis media and describe clinical, audiological and surgical characteristics of patients with acquired middle ear cholesteatoma treated at a referral hospital in the public health system. METHODS Cross-sectional and prospective cohort study, including 1710 patients with chronic otitis media, treated between August 2000 and June 2015, without prior surgery. Detailed clinical history, videotoscopy, and audiometry were performed, in addition to review of medical records to search for surgical data. Cholesteatomas were classified according to their route of formation. RESULTS Of the patients with chronic otitis media, 419 (24.5%) had cholesteatoma; mean age of 34.49 years; 53.5% female and 63.8% adults. Bilateral cholesteatoma was observed in 17.1%. Anterior epitympanic cholesteatoma corresponded to 1.9%; posterior epitympanic, 32.9%; posterior mesotympanic, 33.7%; two routes, 14.8%; and indeterminate, 16.7%. The mean air-bone gap was 29.84dB and did not differ between routes of formation. There were no correlations between gap size and patient age or duration of symptoms. Of the surgical cases, 16.8% underwent closed tympanomastoidectomy and 75.2% open tympanomastoidectomy. CONCLUSION The prevalence of cholesteatoma in patients with chronic otitis media was 24.5% and it was more common in adults than in children. Posterior mesotympanic cholesteatoma was more frequent, with no difference in mean air-bone gap between the different routes of formation. In patients undergoing surgery, open tympanomastoidectomy was the procedure most frequently chosen.

Cholesteatoma in Children: An Overview

Objectives: Describe in children: (1) cholesteatoma growth patterns; (2) conductive hearing loss severity; (3) contralateral ear (CLE) findings. Methods: Cross-sectional study. Videotoscopies of 129 pediatric patients at a tertiary care hospital were analyzed for cholesteatoma growth patterns, air-bone gap, and CLE otoscopic findings. Data were compared with the chi-squared test and analyzed using SPSS. Results: The mean patient age was 12.4 ± 4.36 years. The cholesteatoma growth patterns were anterior epitympanic cholesteatomas (5.4%), posterior epitympanic (21.7%), posterior mesotympanic (43.4%), 2 routes pattern (17.1%), and undetermined (12.4%). The pure tone average air-bone gap (PTA-ABG) was ≤20 dB in 8.7% of patients, between 20 to 40 dB in 43.4% of patients, and ≥40 dB in 47.9%. The CLE was normal in 34.9% of patients and had moderate or severe tympanic membrane (TM) retractions in 46.5%, TM perforation in 7.8%, and cholesteatoma in 10.9% of patients. The CLE disease prevalence was similar between the groups, except in anterior epitympanic group, which had normal CLE (P = .004). Conclusions: Posterior mesotympanic cholesteatomas were the most prevalent in the study population. Most patients had a PTA-ABG greater than 20 dB, and the most prevalent CLE abnormalities were moderate or severe TM retraction and cholesteatoma. The CLE of patients diagnosed with anterior epitympanic cholesteatoma were normal, suggesting a probable congenital origin.

Differences in Acufenometry and Tinnitus Annoyance among Patients with Presbycusis and Ménière’s Disease

Objectives: Analyze the difference in acufenometry between patients with presbycusis and Ménière’s disease and correlate the findings with the annoyance caused by tinnitus. Methods: This cross-sectional study included 59 patients with unilateral tinnitus treated at a tertiary hospital. Out of these patients, 38 had presbycusis and 21 had Ménière’s disease. Acufenometry was performed to determine the pitch and loudness of tinnitus in the 2 groups. The tinnitus handicap inventory (THI) and visual analogue scale (VAS) was used to evaluate the annoyance caused due to tinnitus. Statistical analysis was performed using SPSS and the Student t test. Results: The mean age of the patients with Ménière’s disease and presbycusis was 56.05 ± 8.73 years and 67.74 ± 8.73 years, respectively (P < .0001). Similar tinnitus pitch was observed in patients with Ménière’s disease and those with presbycusis (2119 ± 2000 Hz vs 3092 ± 2203 Hz; P = .09); however, the loudness varied between the groups (61.19 ± 17.2 dB vs 42.17 ± 19.8 dB; P = .001). The THI and VAS score were similar between the two groups (P = .33 vs P = .66). Conclusions: Although tinnitus was louder in patients with Ménière’s disease than in those with presbycusis, the tinnitus pitch and its impact on patient quality of life was similar in both groups.

Ossicular Erosion and Air-Bone Gap in Attic and Tensa Cholesteatomas

Objectives: (1) Compare the air-bone gap between patients with posterior epitympanic (attic) and posterior mesotympanic (tensa) cholesteatomas. (2) Correlate the air-bone gap and intraoperative ossicular chain findings. Methods: Cross-sectional study. In total, 262 patients with attic and tensa cholesteatomas treated at a tertiary hospital were included. Audiometry was performed, and the pure tone average air-bone gap (PTA-ABG) was compared between the 2 groups. In addition, ossicles were classified as normal, eroded, or absent based on intraoperative evaluation. Data were compared using the Mann-Whitney and Chi-square tests, and statistical analysis was performed using SPSS. Results: Attic cholesteatoma was diagnosed in 51.1% of patients and tensa cholesteatoma in 48.9%. The mean patient age was 33 ± 18.7 years, and 52.3% were male patients. The PTA-ABG was higher in tensa cholesteatoma cases than in attic cholesteatoma (30.25 ± 12.82 dB and 26.73 ± 13.08 dB, respectively, P = .031). There were no differences in the malleus erosion or absence prevalence and the stapes suprastructure prevalence (P = .09 and P = .17, respectively). The incus was normal in 17.6% of the attic and 6.3% of tensa cholesteatoma cases; eroded in 79.4% of tensa and 48.6% of attic cases; and absent in 33.8% of attic and 14.3% of tensa cholesteatoma cases (P < .01). Conclusions: The PTA-ABG was higher in tensa cholesteatoma cases and correlated with a lower normal incus prevalence and a higher eroded incus prevalence compared to attic cholesteatoma cases.

Marginal Tympanic Membrane Perforations: A Critical View:

Objectives: (1) Assess the marginal perforation prevalence in patients with chronic otitis media (COM). (2) Analyze evidence suggesting prior moderate or severe tympanic retractions (TM) of the pars tensa in marginal perforation cases. (3) Correlate the abnormal findings with those in the contralateral ear (CLE). Methods: Prevalence study. The bilateral videotoscopies of 1510 patients diagnosed with COM in a tertiary hospital were analyzed. Previous TM retraction was evaluated according to: (1) medialization of the manubrium of malleus, (2) remnant tympanum adhered to the ossicular chain, (3) remnant tympanum adhered to the promontory, and (4) ossicular chain erosion. The videotoscopies of the CLE were also described. Results: Of the 1510 patients evaluated, 34 (2.25%) had marginal TM perforation. Only 5.9% of ears showed no evidence of previous retraction, and 88.3% showed 2 or more abnormal findings. The CLE was diagnosed with perforation-retraction (2.9%), moderate or severe retraction (52.9%), and cholesteatoma (14.7%); 23.5% were normal. Conclusions: The study population had a low marginal perforation prevalence. The vast majority of ears with marginal perforation had evidence suggesting previous TM retraction. In addition, retraction or cholesteatoma occurred in 70.5% of CLE.