Otology | Basics of Cholesteatoma | Mr Mike Wareing

Basics of Cholesteatoma
Mr Mike Wareing - Consultant ENT Surgeon, The Royal London Hospital
Barts ENT Online Teaching Programme,
12th June 2020

Curriculum topics (UK Otolaryngology Higher Surgical Training 2017)
1. Paediatric otolaryngology - Otitis media (acute, chronic and with effusion) and complications and conditions of the external auditory canal
2. Otology - Chronic suppurative otitis media and sequelae

00:38 - Chronic otitis media classification
02:52 - What gets damaged by cholesteatoma
05:31 - Complications - extracranial and intracranial
09:32 - Where do cholesteatoma develop?
14:32 - Symptomatology
15:37 - Preoperative investigations
21:43 - Treatment options
24:37 - Surgical options
25:51 - Canal wall down
27:42 - Small cavity mastoidectomy
29:29 - Endaural and postaural incision
30:21 - Operative step 1 - incision, canalplasty, atticotomy and ossicles
34:03 - Problem areas
43:15 - Operative step 2 - reconstruction
52:08 - Why do cavities discharge?
52:48 - Combined approach tympanoplasty

Questions
57:42 - Management of EAC cholesteatoma
58:12 - MRI preop
59:25 - Approach when operating on only hearing ear
01:00:30 - Use of laser in the cavity
01:01:41 - Addressing the Eustachian tube
01:02:42 - 1 stage ossiculoplasty v delayed
01:03:17 - Approach to a canal fistula
01:04:59 - Technique for removal of cholesteatoma from facial nerve
01:05:31 - When to perform canal wall down as primary procedure
01:05:45 - What to do if no graft material
01:06:09 - Considerations if all disease is cleared