(0901) A Comparison of In-Office Versus Surgical Management of External Auditory Canal Cholesteatoma

Introduction: External auditory canal cholesteatoma is rare, with an incidence of 1 case per every 700,000 individuals. The purpose of this study was to compare treatment outcomes between in-office and surgical management of canal cholesteatoma.

Methods: Retrospective study of all patients at one institution presenting with canal cholesteatoma between 2003-2023. Patients were divided into two cohorts, those managed in-office and those who underwent surgical intervention. Demographics, symptomology, otologic history, interventions, recurrence rates, and audiometric outcomes were recorded.

Results: In total, 21 patients were identified (14 male, 8 female). Baseline audiometric testing demonstrated 3 subjects with mild conductive hearing loss (CHL), 3 with moderate CHL, and 2 with severe CHL. Of the 21, 13 subjects were managed in-office with serial debridements and 8 subjects were managed with surgery (tympanomastoidectomy). There was no significant difference in recurrence rates between in-office (n = 1) and operative groups (n = 0) at an average mean follow-up of 4.1 years (p > 0.05). All subjects in the in-office group had stable hearing at a mean follow-up of 3.1 years. Among surgical subjects, 71% demonstrated improvement in PTA (mean 14db), and 29% had stable hearing.

Conclusions: Surgical intervention may have a chance of hearing improvement for canal cholesteatoma. Conservative in-office management with serial debridements is also a viable option with acceptable recurrence rates and audiometric outcomes compared to operative intervention, and this approach may be considered in those who are poor surgical candidates or with less aggressive disease.