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  • Title: The learning curve in revision cholesteatoma surgery.
    Author: Stankovic M.
    Journal: Am J Otolaryngol; 2013; 34(1):65-71. PubMed ID: 23102887.
    Abstract:
    OBJECTIVE: To review the results of revision surgery for cholesteatoma. STUDY DESIGN: Retrospective review of patient's records. SETTING: Tertiary referral center. PATIENTS: A retrospective study of patients operated for acquired middle ear cholesteatoma during the period 1990-2002 was performed. A total of 758 patients were divided into two groups according to surgical experience, and followed during short-term and long-term period. The cholesteatoma was divided according to location, age of patients, status of auditory ossicles, and bilaterality of disease. INTERVENTIONS: The patients were treated with single canal wall up or wall down, according to the propagation of disease and condition of middle ear. The indications for the reoperations were: recurrent or residual cholesteatoma, resuppuration, and AB gap more than 20 dB. MAIN OUTCOME MEASURES: Type of surgical therapy, localization of cholesteatoma, age of patients, revisions, bilaterality of disease, damage of auditory ossicles and learning curve were analyzed. RESULTS: The number of revision operations was reduced in the second period (from totally 24.3% to 16.4%). Closed technique gave a significantly lower rate of failure. For attic cholesteatoma, adults, bilateral disease, and ossicular damage the rate of revisions was significantly lower with surgical experience. CONCLUSION: Surgical experience was important for reduction of reoperation rate for attic and sinus cholesteatoma, adults, bilateral cholesteatoma, and when closed technique is used.
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