Relationship between tympanic membrane retraction and habitual sniffing in patients with cholesteatoma

Abstract

Conclusion: Habitual sniffing affects the pathogenicity and recurrence of cholesteatoma. Postoperative instructions requesting patients to cease sniffing may reduce the retraction and recurrence of cholesteatoma. Objective: To examine the relationship between tympanic membrane retraction and habitual sniffing in patients with cholesteatoma. Methods: We recruited 98 patients (102 ears) who were surgically treated for cholesteatoma by canal wall-down tympanoplasty (22 ears) or canal wall-down tympanoplasty with reconstruction methods (80 ears). We classified these patients into two groups on the basis of their preoperative habitual sniffing: habitual and non-habitual sniffers. The findings of the contralateral tympanic membrane were examined in each group and were classified according to the Tos classifications. Next, we evaluated the incidence of 1-year postoperative tympanic membrane retraction treated by the canal-down tympanoplasty with reconstruction method in the following three groups: non-habitual sniffing group, sniffing cessation group, and continual sniffing group. Results: In habitual sniffers, the Tos classifications of contralateral tympanic membrane were normal in 7% (3/41). In contrast, for non-habitual sniffers, the findings were normal in 39% (21/54). These results indicate that sniffing causes tympanic membrane retraction. The tympanic membranes of patients in the sniffing cessation group were largely normal after surgery. However, more than 50% of the patients who continued to sniff after surgery showed retraction or recurrent cholesteatoma.

Keywords::

• Acquired cholesteatoma
• contralateral tympanic membrane retraction
• continual sniffing
• sniffing cessation
• postoperative retraction of the tympanic membrane
• tympanoplasty

Acknowledgments

This work was supported by a Grant-in-Aid for WAKATE-B (no. 23791890) from the Japan Society for the Promotion of Science (to K.S.). Furthermore, we would like to thank Editage for providing editorial assistance.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.