Premium
Cost analysis and outcomes of a second‐look tympanoplasty‐mastoidectomy strategy for cholesteatoma
Author(s) -
Crowson Matthew G.,
Ramprasad Vaibhav H.,
Chapurin Nikita,
Cunningham Calhoun D.,
Kaylie David M.
Publication year - 2016
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25941
Subject(s) - cholesteatoma , mastoidectomy , medicine , tympanoplasty , surgery , audiology
Objectives/Hypothesis To analyze cost and compare cholesteatoma recidivism and hearing outcomes with single‐stage and second‐look operative strategies. Study Design Retrospective review and cost analysis. Methods Adult and pediatric patients who underwent a tympanoplasty with mastoidectomy for cholesteatoma with a single‐stage or second‐look operative strategy were identified. Variables included procedure approach, residual or recurrent cholesteatoma, ossicular chain reconstruction frequency, and operative complications. Audiologic outcomes included pre‐/postoperative air bone gap (ABG) and word recognition score (WRS). Cost analysis included charges for consultation and follow‐up visits, surgical procedures, computed tomography temporal bone scans, and audiology visits. Results One hundred and six patients had a tympanoplasty with mastoidectomy for cholesteatoma, with 80 canal wall‐up procedures (CWU) as initial approach. Of these, 46 (57.5%) CWU patients had a planned second look. Two (4.3%) CWU patients had recurrent cholesteatoma and 20 (43.4%) had residual identified at second look. Four (11.7%) single‐stage CWU strategy patients developed recurrent cholesteatoma. There was no significant difference in pre‐/postoperative ABG and WRS between second look and single stage ( P > 0.05). Compared to second‐look patients, single‐stage patients had significantly fewer postoperative visits (6.32 vs. 10.4; P = 0.007), and significantly lower overall charges for care ($23,529. vs. $41.411; P < 0.0001). Conclusion The goal of cholesteatoma surgery is to produce a safe ear, and a second‐look strategy after CWU has historically been used to evaluate for recurrent or residual disease. The cholesteatoma recurrence rate at a second look after a CWU tympanoplasty‐mastoidectomy is low. Costs of operative procedures are a significant proportion of healthcare resource expenditures. Considering the low rate of cholesteatoma recurrence and relatively high cost of care, implementation of a second‐look strategy should be individually tailored and not universally performed. Level of Evidence 4. Laryngoscope , 126:2574–2579, 2016