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- Title
Cost analysis and outcomes of a second-look tympanoplasty-mastoidectomy strategy for cholesteatoma.
- Authors
Crowson, Matthew G.; Ramprasad, Vaibhav H.; Chapurin, Nikita; Cunningham, Calhoun D.; Kaylie, David M.
- Abstract
<bold>Objectives/hypothesis: </bold>To analyze cost and compare cholesteatoma recidivism and hearing outcomes with single-stage and second-look operative strategies.<bold>Study Design: </bold>Retrospective review and cost analysis.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusion: </bold>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.<bold>Level Of Evidence: </bold>4. Laryngoscope, 126:2574-2579, 2016.
- Subjects
CHOLESTEATOMA; TYMPANOPLASTY; MASTOIDECTOMY; MEDICAL care costs; DISEASE relapse; SURGICAL complications; EAR ossicles; TREATMENT effectiveness; THERAPEUTICS; MASTOID process surgery; COMPARATIVE studies; RESEARCH methodology; MEDICAL cooperation; POSTOPERATIVE period; REOPERATION; RESEARCH; RESEARCH funding; COST analysis; EVALUATION research; RETROSPECTIVE studies
- Publication
Laryngoscope, 2016, Vol 126, Issue 11, p2574
- ISSN
0023-852X
- Publication type
journal article
- DOI
10.1002/lary.25941