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  • Title: [Cholesteatoma of the middle ear. Choice of technique and results in the adult and child].
    Author: Charachon R, Roux O, Eyraud S.
    Journal: Ann Otolaryngol Chir Cervicofac; 1980; 97(1-2):65-78. PubMed ID: 7469278.
    Abstract:
    On the basis of a series of 577 tympanoplasties performed between January 1968 and December 1978 for 424 cholsteatomas and 153 epidermisations involving 464 adults and 113 children aged less than 15 years, the authors describe techniques, results and indications. An open technique was used in only 28 cases. Since 1973, the authors have preferred the closed technique in two stages (227 cases) to a, closed technique in 1 stage (113 cases). The open technique with obliteration was used in 68 cases in one stage and in 141 cases in 2 stages. This latter group included 17% of patients referred from elsewhere and already operated upon. Rates of tympanic closure varied between 93% for open techniques and 97% for closed techniques and open techniques with obliteration. The presence of silastic caused a fall in this closure rate of a little more than 2% both in the closed technique (94,8%) as well as in the open technique with obliteration (94,4%). An appreciably difference between the adult and child was seen only with the open technique with obliteration in two stages: 96% in the adult, 83% in the child. Residual cholesteatoma pearls extirpated during the 2nd stage were found in 28% of cases in the adult and in 36% of cases in the child in closed techniques and in 21% of cases in the adult and 33% of cases in the child in open techniques with obliteration. Retraction pockets were fairly common after the closed technique in one stage (6 out of 35 at 5 years). They were nevertheless also seen after closed techniques in two stages (5 out of 81 at one year and 3 out of 29 at 3 years). The best functional results were obtained with closed techniques in 2 stages. The air-bone gap was 10 dB or less in 44% of cases and 20 dB or less in 63% of cases when the stapes was intact. It was 10 dB or less in 31% of cases and 20 dB or less in 45% of cases when the stapes was destroyed. There was no appreciable difference between adults and children for a given technique. The closed technique in two stages is preferable, in particular when the mastoid is pneumatised and/or if the cholesteatoma is large or papillary, which is customary in the child. The open technique with obliteration is preferable if the wall of the mastoid antrum is destroyed if the mastoid is severely retracted and if the eustachian tube functions poorly. It is also the method indicated in the presence of a large retraction pocket.
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