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Master Thesis

Étude du comblement osseux dans la chirurgie du cholestéatome par application de modèles multi-états

Abstract : Introduction: Cholesteatoma is a benign but agressive epidermictumour of middle ear and posterior mastoidian cavity. Treatment of this pathology is radical surgical resection, but a new post surgery retraction pocket can occur and define a cholesteatoma recurrence and residual cholesteatoma results of incomplete surgical removal of the cholesteatoma matrix. Mastoid and attic obliteration seems to decrease recurrent and residual cholesteatoma. We found very few comparative studies on the mastoid obliteration. Multistate statistical survival models can be adapted to this type of chronic ear diseases. Method: A retrospective monocentric study was conducted on a cohort of patients who benefited of cholesteatoma surgery by canal wall up and canal wall down technique on a ten years period (2008-2018) by one skilled otologist who used mastoid obliteration with Bone Pâté since 2013. Non parametric and parametric multistate survival models (Semi Markovian) with adjustement propensity score ponderation (IPW method) were used. Results: Mastoid obliteration was a good protective technique for recurrent cholesteatoma risk (HR= 0.14, p<0.01) or residual cholesteatoma (HR=0.06, p<0.01) but didn't change the risk of new functional surgery (HR=1.05, p=0.84). Obliteration with bone pâté didn't decrease audioloc results (p=0.66) and is a safe and easy technique.
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Master Thesis
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Christol Fabre. Étude du comblement osseux dans la chirurgie du cholestéatome par application de modèles multi-états. Médecine humaine et pathologie. 2019. ⟨dumas-02333950⟩

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