Management of cholesteatoma complications: Our experience in 145 cases

Objectives: To assess the incidence, clinical features, diagnosis and treatment of complications of cholesteatomatous chronic otitis media (CCOM) seen in the ENT/Head and Neck Surgery Clinic, University Clinical Center of Kosova, Prishtina. Materials and Methods: This is a retrospective study of the medical records of patients with complications of CCOM who had undergone surgical treatment at the ENT Clinic of the University Clinical Center of Kosovo for the period time of 1994 to 2011. Results: From a total of 2765 patients suffering from COM, 502 (18.08%) had cholesteatoma. From this group, in 145 patients had complications. The mean age was 30 years. Eighty-two (56.55%) cases had extracranial complications (ECC) and 49 patients (33.79%) intracranial complications (ICC). For the ECC cases, we found that subperiostal mastoid abscess occurred in 25%, facial nerve palsy was seen in 13% and labyrinthine fistula in 9.6 %. For the ICC cases, meningitis (12%) and perisinusal abscess (11%) were the most common complications. The most frequent radiological diagnostic procedures were mastoid X-rays, which were performed in 70% of the patients, and computed tomography in 20%. Patients with ECC were treated in the ENT Clinic, whereas patients with ICC, after otologgic surgical procedures, were transferred to the Neurosurgery Clinic. In this series, 5 patients (3.4%) died as a result of complications. Conclusions: The incidence of cholesteatoma and its complications in our country still poses a challenge that requires higher dedication. Application of sophisticated diagnostic methods, CT and MRI is going to assist in choosing the adequate surgical approach, especially in cases with intracranial complications.