Diagnosis and management of aggressive, acquired cholesteatoma with skull base and calvarial involvement: a report of 3 cases

A prospective case review of 3 patients treated at a tertiary referral center from 1997 to 2002 are presented. Three men, age 30 to 68 (mean, 45) years, were treated for acquired cholesteatoma with skull base invasion. Two patients had no prior otological surgery, and 1 was detected after 4 prior mastoid procedures. One presented with progressive unilateral facial palsy, 1 with otorrhea, and 1 with temporal mass above a modified radical mastoidectomy cavity. All 3 patients were treated with single-staged canal wall-down mastoidectomy. Patients were followed up with otoscopy and neuroimaging from 40 to 61 months. Two patients had no recurrence of cholesteatoma, and 1 had squamous debris in the mastoid cavity removed in the outpatient clinic. One had complete ipsilateral facial nerve paralysis preoperatively and recovered to House-Brackmann grade III within 1 year of surgery. Patient 1 had labyrinthine involvement before surgery and had ipsilateral anacusis after resection and repair. No other complications occurred. Initial presentation, workup, surgical challenges, disease follow-up, facial nerve function, hearing results, and complications are reported.