“The Modern Day Management of Chronic Otitis Media/Cholesteatoma: Combining European and American Perspectives Over a Half-Century of Combined Experience”

Alexandre Karkas, MD, PhD 2 , Ravi N. Samy, MD, FACS 1

1LVHN/Jefferson Health, Sidney Kimmel College of Medicine, Thomas Jefferson University, Professor and Chief, OHNS

2Alexandre Karkas, MD, PhD, Professor and Chairman, Dept. of OHNS, University Medical Center of Saint-Etienne

Background & Aim

Modern day management of epidermoid cysts/cholesteatomas/chronic otitis media is still a challenge and a conundrum. While the principles never change (i.e., making an ear clean, safe, and dry), adapting new technologies and treatment modalities should reduce the morbidity of this disease and improve the potential for rehabilitation (e.g., auditory, vestibular, and facial).

Material & Methods

The 2 presenting physicians will review their cases over their prior 25 years each (between fellowship and attending level practice)

Results

The physicians have used a variety of approaches to treat their cholesteatomas, including: 1) standard otologic approaches: transmastoid (CWD/CWU/CWR mastoidectomy), transcanal, endaural 2) mastoid obliterations with bone pate/bioactive glass 3) skull base approaches (middle cranial fossa, retrosigmoid, retrolabyrinthine/translabyrinthine). The endoscope has been important to assess for hidden cholesteatomas. MRI DWI images have reduced the need for 2nd looks while monitoring for recurrence. The laser has been useful to eradicate microscopic disease. One presenter is investigating the use of oncolytic virus in animal models for eradication of disease. This will also be discussed. And finally, the utilization of adjunctive techniques and technologies will discuss how to manage any deficits (e.g., hearing, balance, or facial nerve related).

Conclusions

The evolution of the management of COM/cholesteatoma continues unabated. While the progress may be slow, it is steady and shows the promise for a disease that has existed for 1000’s of years of mankind’s history. The case examples show how otolaryngologists can continue to learn and progress in the management of this challenging disease.

Keywords

cholesteatoma, chronic otitis media, laser, endoscopy, mastoid obliteration, microscope, MRI, otologic drill, bone pate, bioactive glass

Additional Info

The presenters (Drs. Ravi N. Samy and Alex Karkas) will include video presentations of their significant and vast experiences.