Abstract
Cholesteatoma invasion into the internal auditory canal (IAC) is rare and usually results in irreversible, complete hearing loss and facial paralysis on the affected side. This retrospective study examines the clinical characteristics of seven patients with cholesteatoma invading the IAC, analyzes possible routes of the cholesteatoma’s extension and describes the surgical approaches used and patient outcome. Extension to the IAC was via the supralabyrinthine route in most patients. A subtotal petrosectomy, a translabyrinthine approach or a middle cranial fossa approach combined with radical mastoidectomy were required for the complete removal of the cholesteatoma. All seven patients presented with some preoperative facial nerve palsy. The facial nerve was decompressed in four patients and facial nerve repair was performed in three others, two by hypoglossal-facial anastomosis and one by a greater auricular nerve interposition grafting. All patients ended up with total deafness in the operate ear. At 1 year following surgery, the facial nerve function was House–Brackmann grade III in six cases and grade II in one. In conclusion, cholesteatoma invading the IAC is a separate entity with characteristic clinical presentations, require a unique surgical approach, and result in significant morbidity, such as total deafness in the operated ear and impaired facial movement.
Similar content being viewed by others
References
Bartels LJ (1991) Facial nerve and medially invasive petrous bone cholesteatomas. Ann Otol Rhinol Laryngol 100:308–317
Hawthorne MR, Fisch U (1988) The surgical management of supralabyrinthine and infralabyrinthine-apical cholesteatoma of the temporal bone. In: Fisch U (ed) Neurologic surgery of the ear and the skull base. Kugler & Ghedini Publications, Amsterdam, pp 11–19
Yanagihara N, Matsumoto Y (1981) Cholesteatoma in the petrous apex. Laryngoscope 91:272–279. doi:10.1288/00005537-198102000-00016
Griffin C, DeLaPaz R, Enzmann D (1987) MR and CT correlation of cholesterol cysts of the petrous bone. AJNR Am J Neuroradiol 8:825–829
Bumsted RM, Sade J, Dolan KD, McCabe BF (1977) Preservation of cochlear function after extensive labyrinthine destruction. Ann Otol Rhinol Laryngol 86:131–137
Atlas M, Moffat D, Hardy D (1992) Petrous apex cholesteatoma: diagnostic and treatment dilemmas. Laryngoscope 102:1363–1369. doi:10.1288/00005537-199212000-00010
Smith PG, Leonetti J, Kletzker R (1988) Differential clinical and radiographic features of cholesterol granulomas and cholesteatomas of the petrous apex. Ann Otol Rhinol Laryngol 97:599–604
Cawthorne T, Griffith A (1961) Primary cholesteatomata of the temporal bone. Arch Otolaryngol 73:252–261
Flood LM, Kemink JL, Graham MD (1985) The investigation and management of petrous apex erosion. J Laryngol Otol 99:439–450
Horn KL, Shea JJ, Brackmann DE (1985) Congenital cholesteatoma of the petrous pyramid. Arch Otolaryngol 111:621–623
Chu FWK, Jackler RK (1988) Anterior epitympanic cholesteatoma with facial paralysis: a characteristic growth pattern. Laryngoscope 98:274–279
Latack JT, Kartush J, Kemick J, Graham M, Knake J (1985) Epidermoidomas of the cerebellopontine angle and temporal bone: CT and MR aspects. Radiology 157:361–366
Robert Y, Carcasset S, Rocourt N, Hennequin C, Dunbrulle F (1995) Congenital cholesteatoma of the temporal bone: MR findings and comparison with CT. AJNR Am J Neuroradiol 16:755–761
Magliulo G (1998) Petrous bone cholesteatoma and facial paralysis. Clin Otolaryngol 23:253–258. doi:10.1046/j.1365-2273.1998.00144.x
Silver AJ, Janecka I, Waze J, Hilal SK, Rutledge JN (1987) Complicated cholesteatomas: CT findings in inner ear complications of middle ear cholesteatomas. Radiology 164:47–51
Ishii K, Takahashi S, Matsumoto K, Kobayashi T, Ishibashi T, Sakamoto K et al (1991) Middle ear cholesteatoma extending into the petrous apex: evaluation by CT and MR imaging. AJNR Am J Neuroradiol 12:719–724
Glasscock MEIII, Woods CI, Poe DS, Patterson AK, Welling DB (1989) Petrous apex cholesteatoma. Otolaryngol Clin North Am 22:981–1002
Sanna M, Zini C, Gamoletti R, Frau N, Taibah AK, Russo A et al (1993) Petrous bone cholesteatoma. Skull Base Surg 3:201–213
Yanagihara N, Nakamura K, Hatakeyama T (1992) Surgical management of petrous bone cholesteatoma: a therapeutic scheme. Skull Base Surg 2:22–27
House JW, Brackmann DE (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93:146–147
De Foer B, Vercruysse JP, Pilet B et al (2006) Single-shot, turbo spin-echo, diffusion-weighted images versus spin-echo-planar, diffusion-weighted imaging in the detection of acquired middle ear cholesteatoma. AJNR Am J Neuroradiol 27:1480–1482
Ozbek C, Tuna E, Ciftci O, Yazkan O, Ozdem C (2008) Incidence of fallopian canal dehiscence at surgery of chronic otitis media (Epub ahead of print)
Magliulo G (2007) Petrous bone cholesteatoma: clinical longitudinal study. Eur Arch Otorhinolaryngol 264:115–120. doi:10.1007/s00405-006-0168-x
Mustafa A, Heta A, Kastrati B, Dreshaj S (2008) Complications of chronic otitis media with cholesteatoma during a 10-year period in Kosovo (Epub ahead of print)
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Migirov, L., Bendet, E. & Kronenberg, J. Cholesteatoma invasion into the internal auditory canal. Eur Arch Otorhinolaryngol 266, 657–662 (2009). https://doi.org/10.1007/s00405-008-0804-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-008-0804-8