Bilateral Middle Ear Cholesteatoma: Epidemiological, Clinical, and Therapeutic Challenges in a Moroccan Cohort

ENT Head and Neck Surgery Department, 20 August Hospital, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II University Casablanca, Morocco

*Corresponding author: Hajar Boudhar, ENT Head and Neck Surgery Department, 20 August Hospital, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II University Casablanca, Morocco, Phone: 0678328423; Email: [email protected]

Received Date: March 10, 2026

Published Date: April 23, 2026

Citation: Boudhar H, et al. (2026). Bilateral Middle Ear Cholesteatoma: Epidemiological, Clinical, and Therapeutic Challenges in a Moroccan Cohort. Mathews J Otolaryngol. 5(1):14.

Copyrights: Boudhar H, et al. © (2026).

ABSTRACT

Introduction: Bilateral middle ear cholesteatoma is a rare but severe form of chronic otitis media, characterized by keratinizing squamous epithelium in the middle ear, leading to complications such as hearing loss, facial paralysis, and intracranial involvement. Despite extensive research on unilateral cases, bilateral cholesteatoma remains understudied, particularly in resource-limited settings. This study aims to analyze its epidemiological, clinical, and therapeutic particularities. Materials and Methods: A retrospective study was conducted in our department from 2021 to 2025 involving 54 patients with surgically confirmed bilateral cholesteatoma. Data included demographic characteristics, clinical presentation, imaging (CT scans), surgical techniques (canal-wall-up vs. canal-wall-down), and postoperative outcomes. Statistical analysis was performed using SPSS. Results: The cohort showed a male predominance (55.5%) and a mean age of 17 years, with 33.3% aged 10–20. Diagnostic delay averaged 10 years, and complications included meningitis (3.7%) and facial paralysis (1.85%). CT scans revealed ossicular erosion (81.5%) and tegmen tympani erosion (44.4%). Closed techniques were preferred (77.5%), yielding a 7.4% recurrence rate vs. 1.85% for open techniques. Hearing improvement averaged 5–32 dB, with 27.3% achieving a Rinne gap <20 dB. Discussion: Bilateral cholesteatoma poses unique challenges due to its aggressive nature and need for bilateral hearing preservation. The high diagnostic delay underscores gap in early detection, while conservative surgical approaches balanced recurrence risk with functional outcomes. CT imaging proved critical for preoperative planning. Limitations included lost-to-follow-up (61.1%) and short follow-up duration (22 months). Conclusion: Bilateral cholesteatoma requires tailored surgical strategies and rigorous follow-up to mitigate recurrence. Future efforts should prioritize early screening, advanced imaging (e.g., MRI), and standardized protocols in similar settings.

Keywords: Bilateral Cholesteatoma, Chronic Otitis Media, Ossicular Erosion, Canal-Wall-Up, Hearing Preservation, Diagnostic Delay, Surgical Outcomes.