Current trends in the management of the complications of chronic otitis media with cholesteatoma

Sampath C. Prasad, Seung Ho Shin, Alessandra Russo, Giuseppe Di Trapani, Mario Sanna

Research output: Contribution to journalReview articlepeer-review

47 Scopus citations


Purpose of Review: Complications of cholesteatoma can be of a different nature from those of other otitis media. This review aims to undertake an analysis of current literature regarding management of the complications of cholesteatoma. Recent Findings: Despite a significant decline in the incidence of complications secondary to cholesteatoma in developed countries it is still a considerable problem in the developing countries. Among intratemporal complications, facial nerve paralysis and labrynthine fistula and among intracranial complications, meningitis, brain abscess and lateral sinus thrombosis are most common. In cases of facial nerve paralysis, decompression with complete disease eradication is considered to be the mainstay of treatment and usefulness of an epineural incision and the range of the decompression are still debatable. Labyrinthine fistula is commonly managed by a single staged matrix removal, followed by closure of the fistula. Partial labrynthectomy in difficult cases is gaining favor among surgeons today. Meningitis and brain abscesses are treated with antibiotics and steroid therapy followed by surgery when the patient is neurologically stable. In lateral sinus thrombosis, mastoidectomy and removal of infected tissue is the primary treatment. Sinus incision and thrombectomy does not seem to improve recanalization and anticoagulation is usually not necessary. Treatment of meningoencephalic herniations is based mainly on the diameter of the herniation. Summary: There is considerable debate in the management of almost every complication of cholesteatoma. Multicentric studies to compare the efficacies of various treatment modalities are the need of the hour to come to definitive conclusions regarding the best treatment options.

Original languageEnglish
Pages (from-to)446-454
Number of pages9
JournalCurrent Opinion in Otolaryngology and Head and Neck Surgery
Issue number5
StatePublished - Oct 2013


  • brain abscess
  • cholesteatomatous chronic otitis media
  • chronic otitis media
  • facial nerve paralysis
  • labyrinthine fistula
  • lateral sinus thrombosis
  • meningitis
  • meningoencephalitic herniation
  • otitis media


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