Comparisons with other studies
Preoperative differences in HRQoL were observed mainly for patients with
COM with pars tensa cholesteatoma having a significantly better HRQoL
compared to other types of CMED. COM with pars tensa cholesteatoma
frequently follows retraction pockets and atelectasis. The latter
conditions are commonly followed with regular ENT examinations and
therefore, COM with pars tensa cholesteatoma may be diagnosed at an
early stage with no or only mild symptoms associated. Moreover, the
present cohort of COM with pars tensa cholesteatoma exhibited a
relatively moderate preoperative hearing impairment, which may also
explain the relatively low impairment of HRQoL. A tendency to higher
preoperative HRQoL scores was observed in patients undergoing functional
surgery (COM without cholesteatoma, persistent mastoid cavity without
recurrent cholesteatoma, revision ossiculoplasty for hearing
restoration). This is in line with recent studies showing differing
HRQoL in patients with cholesteatoma and persistent mastoid
cavity.17,18 Patients with cholesteatoma tend to score
lower in the ZCMEI-21 total score preoperatively and exhibited a smaller
change in ZCMEI-21 total scores in comparison to patients undergoing
mastoid cavity obliteration.17,18 Accompanying
symptoms of mastoid cavity (caloric vertigo, otorrhea, regular
consultations with physicians) may explain higher subjective complaints
in contrast to the frequently missing clinical symptoms of
cholesteatoma.17 In this study, the analysis of
specific symptoms revealed the highest occurrence of ear discharge and
vertigo in patients with persistent mastoid cavities regardless of the
presence of cholesteatoma. Worst HRQoL was observed in the cohort with
persistent mastoid cavity without cholesteatoma. With the absence of
cholesteatoma, surgery should be cautiously indicated, and individual
complaints need to be taken into account. In contrast, the treatment
indication in presence of cholesteatoma directly arises with the
diagnosis and does not depend on the patient’s
symptoms.20,21 For other CMED, such as persistent
mastoid cavity without cholesteatoma, impairment in HRQoL usually
contributes to the decision for surgical treatment.17In otology, measuring and analysing HRQoL complements traditional,
objective outcomes, such as pure tone audiometry. Even though
questionnaires cannot replace a comprehensive clinical history, which
also assesses the patient’s individual expectations from surgical
procedures, validated instruments can be a helpful tool for quantifying
HRQoL in clinical practice and research.6,18,22