Cost analysis and outcomes of a second-look tympanoplasty-mastoidectomy strategy for cholesteatoma

Laryngoscope. 2016 Nov;126(11):2574-2579. doi: 10.1002/lary.25941. Epub 2016 Mar 1.

Abstract

Objectives/hypothesis: To analyze cost and compare cholesteatoma recidivism and hearing outcomes with single-stage and second-look operative strategies.

Study design: Retrospective review and cost analysis.

Methods: Adult and pediatric patients who underwent a tympanoplasty with mastoidectomy for cholesteatoma with a single-stage or second-look operative strategy were identified. Variables included procedure approach, residual or recurrent cholesteatoma, ossicular chain reconstruction frequency, and operative complications. Audiologic outcomes included pre-/postoperative air bone gap (ABG) and word recognition score (WRS). Cost analysis included charges for consultation and follow-up visits, surgical procedures, computed tomography temporal bone scans, and audiology visits.

Results: One hundred and six patients had a tympanoplasty with mastoidectomy for cholesteatoma, with 80 canal wall-up procedures (CWU) as initial approach. Of these, 46 (57.5%) CWU patients had a planned second look. Two (4.3%) CWU patients had recurrent cholesteatoma and 20 (43.4%) had residual identified at second look. Four (11.7%) single-stage CWU strategy patients developed recurrent cholesteatoma. There was no significant difference in pre-/postoperative ABG and WRS between second look and single stage (P > 0.05). Compared to second-look patients, single-stage patients had significantly fewer postoperative visits (6.32 vs. 10.4; P = 0.007), and significantly lower overall charges for care ($23,529. vs. $41.411; P < 0.0001).

Conclusion: The goal of cholesteatoma surgery is to produce a safe ear, and a second-look strategy after CWU has historically been used to evaluate for recurrent or residual disease. The cholesteatoma recurrence rate at a second look after a CWU tympanoplasty-mastoidectomy is low. Costs of operative procedures are a significant proportion of healthcare resource expenditures. Considering the low rate of cholesteatoma recurrence and relatively high cost of care, implementation of a second-look strategy should be individually tailored and not universally performed.

Level of evidence: 4. Laryngoscope, 126:2574-2579, 2016.

Keywords: Cholesteatoma; mastoidectomy; second look; tympanoplasty.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Cholesteatoma, Middle Ear / pathology
  • Cholesteatoma, Middle Ear / surgery*
  • Costs and Cost Analysis*
  • Female
  • Humans
  • Male
  • Mastoid / surgery
  • Middle Aged
  • Postoperative Period
  • Recurrence
  • Retrospective Studies
  • Second-Look Surgery / economics*
  • Second-Look Surgery / methods
  • Treatment Outcome
  • Tympanoplasty / economics*
  • Tympanoplasty / methods
  • Young Adult