An analysis of mastoid cholesteatomas

Fifty‐five extensive mastoid cholesteatomas filling all the air cell system were found in our material of 2,192 operated‐on chronic ears. They concentrated in younger age groups than ordinary cholesteatomas, although they could also be seen in older people. In the group, 95% of them had attic or posterosuperior perforation. In one‐fourth of the cases the tympanum was also epidermized. The main bacteria were Proteus strains, Staphylococcus aureus/epidermidis, E. coli and Pseudomonas aeruginosa. Preoperatively, cholesteatoma could always be diagnosed but its mastoid type could be predicted only in a minority (13%) of cases. Roentgenology proved an unreliable means for revealing cholesteatoma. The extent of the mastoid air cell system varied from extensive to small depending only on the patient's age, with a correlation of smaller size to higher age. Of the ears studied, 16% were complicated and all belonged to the adult group. The growth characteristics of these extensive cholesteatomas are basically the same as in other cholesteatomas, the only difference being that, due to especially favorable environmental conditions at present unknown, the epidermosis takes the form of a more aggressive and active spreading in soft connective tissue. The effect on bone is lytic and relatively slow, passive. The operation, which must aim at the complete eradication of the cho‐lesteatomatous process, did not essentially improve the hearing. On the other hand, only two ears drained postoperatively and only one had to be reoperated on, revealing residual cholesteatoma tympanally. Thus, this material with most difficult and dangerous middle ear cleft pathology, gave conclusive proof that the obliterative operation technique was safe and appropriate regardless of the quality and extent of the process.