Iatrogenic cholesteatoma arising from the vascular strip

Laryngoscope. 2017 Mar;127(3):698-701. doi: 10.1002/lary.26093. Epub 2016 Jun 16.


Objectives/hypothesis: To highlight the phenomenon of cholesteatoma arising from the vascular strip following tympanoplasty and tympanomastoidectomy.

Study design: Multi-institutional retrospective chart review.

Methods: Consecutive adult and pediatric patients evaluated between 2000 and 2015 with acquired cholesteatoma arising from the skin of a prior vascular strip were identified. Patients with evidence of residual or recurrent cholesteatoma elsewhere in the middle ear, mastoid, or ear canal were excluded.

Results: Seventeen cases (71% female, 53% right-sided) were identified, and the mean age at presentation was 39.2 years. Patients presented on average 12.9 years following prior otologic surgery, which was most commonly tympanoplasty without mastoidectomy (59%). However, younger patients presented with symptoms sooner following prior surgery (r = 0.61, r2 = 0.37, P = 0.0095). The most common presenting symptom was otorrhea (76%). All patients were found to have mastoid cholesteatoma with bony erosion, and three patients exhibited additional tegmen or posterior fossa bone defects. The middle ear was not involved with cholesteatoma in any case. A canal wall down procedure was performed due to extensive bony canal erosion in 29% of cases.

Conclusion: The vascular strip is an uncommon source of iatrogenic cholesteatoma that can present years following an otherwise uncomplicated otologic surgery. The findings presented herein highlight the importance of careful vascular strip orientation at the conclusion of otologic surgery.

Level of evidence: 4. Laryngoscope, 127:698-701, 2017.

Keywords: Otology; cholesteatoma; iatrogenic; temporal bone; tympanomastoidectomy; tympanoplasty; vascular strip.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Age of Onset
  • Child
  • Child, Preschool
  • Cholesteatoma, Middle Ear / diagnostic imaging
  • Cholesteatoma, Middle Ear / epidemiology*
  • Cholesteatoma, Middle Ear / etiology*
  • Cholesteatoma, Middle Ear / surgery
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Iatrogenic Disease / epidemiology*
  • Incidence
  • Male
  • Mastoid / surgery*
  • Reoperation / methods
  • Retrospective Studies
  • Risk Assessment
  • Sex Distribution
  • Tomography, X-Ray Computed / methods
  • Treatment Outcome
  • Tympanic Membrane / blood supply*
  • Tympanic Membrane / pathology
  • Tympanoplasty / adverse effects*
  • Tympanoplasty / methods
  • Young Adult