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