Management of Complicated Cholesteatomas: A Series of 109 Cases

Goal: To analyze the epidemiological, clinical, paraclinical, and therapeutic features of complicated cholesteatomas of the middle ear.
Materials and Methods: A retrospective study was conducted at the Department of Otorhinolaryngology and Cervicofacial Surgery of Mohammed VI University Hospital in Marrakech, over an 18-year period from January 2005 to December 2023, involving 109 patients operated on for complicated middle ear cholesteatomas. Patients with uncomplicated cholesteatomas, non-cholesteatomata’s chronic otitis media, and incomplete medical records were excluded.
Results: The mean age of patients was 47.6 years (range: 2–65), with a male predominance (sex ratio 1.37). The most affected age group was 16–30 years (46.79%). All patients presented with fetid otorrhea, and 77.1% had associated hearing loss. The leading complications were otomastoiditis (41.3%), peripheral facial nerve paralysis (23%), labyrinthine fistula (9.2%), lateral sinus thrombophlebitis (8.3%), meningitis (7.3%), Bezold abscess (5.5%), labyrinthitis (1.8%), brain abscess (1.8%), and meningoencephalitis (1.8%). CT scan revealed aggressive soft tissue opacification in 100% of cases, with ossicular chain lysis in 72.4%, facial canal erosion in 40.3%, and semicircular canal lysis in 24.7%. An open (canal wall down) tympanoplasty technique was performed in 82.5% of patients, while a closed (canal wall up) technique was used in 17.4%. Oculoplasty was performed in 42.2% of cases. Postoperative hearing was improved in 30% and preserved in 65% of patients. Facial nerve recovery was complete in 70% of affected patients.
Conclusion: Complicated cholesteatomas remain a significant health concern, particularly in developing countries where delayed consultation is common. Early diagnosis, appropriate imaging, and timely combined medical and surgical management are essential to improve functional outcomes and prevent potentially fatal intracranial complications.