Comparison of Primary and Secondary Cholesteatomas in Terms of Ossicular Destruction and Complications

Abstract

Objective: Cholesteatomas are divided into two groups by their origin: primary (attic) and secondary (tensa). It is highly probable that these two types differ by etio-pathogenetic mechanisms. In this study, we aimed to compare these groups in terms of complications and ossicle destruction.Methods: Sixty-six consecutive patients, operated on between June 2012 and March 2014 in our department for cholesteatoma, were included in this study. The status of the ossicles was scored according to the Austin-Kartush classification between 0-7, and sub-groups were created according to the magnitude of the ossicle damage: primary-A (PrA), primary-B (PrB), secondary-A (SecA) and secondary-B (SecB).Results: Thirty-eight patients had secondary cholesteatomas, and 28 patients had primary cholesteatomas. The average ages for primary and secondary patients were 38.4 and 42.6, respectively. All 5 patients under the age of 16 had primary cholesteatomas. Austin-Kartush score averages for the primary and secondary groups were not statistically different. However, when the PrA and SecA groups (patients with less ossicular damage) were compared statistically, the SecA group was found to have a significantly higher average score than the PrA group, which reflects less damage. Furthermore, the number of patients with complications and the number of complications were significantly higher in the primary group.Conclusion: Primary and secondary cholesteatomas seem to differ from each other etio-pathogenetically. Secondary cholesteatomas are diagnosed with less ossicular damage compared to their primary counterparts, and this finding is attributed to the fact that primary cholesteatomas can not drain into the external ear canal, which leads to more destruction and complications.

Keywords

• cholesteatoma
• primary
• secondary
• ossicles
• austin-kartush classification