Socioeconomic Analysis of Patients with Recurrent Cholesteatoma

Introduction: Cholesteatomas are generally non-cancerous growths in the air-filled spaces of the temporal bone of the skull; however, they can be destructive and invasive. Our goal is to identify any socioeconomic disparities in patients with recurrent cholesteatomas and highlight differences in presentation.

Methods: A retrospective chart review from 2014-2024 at Loyola University Medical Center was conducted for all patients who underwent primary or revision surgery for a cholesteatoma. Demographic variables included race, ethnicity, insurance type, and zip code approximating the CDC’s social vulnerability index (SVI). Medical variables included prior history of ear surgery, comorbidities, location of cholesteatoma, complications, and recurrence.

Results: 624 patients were identified with 56.1% male and 74.8% identified as White/Caucasian and Non-Hispanic. Average age at surgery was 47. 26.3% of patients had Medicaid or Medicare for primary health insurance. Patients on average had an SVI score of 0.56 representing a moderate degree of vulnerability. Of the patients presenting for cholesteatoma evaluation, a significant proportion of patients presented for revision surgeries at 43%. There were no statistically significant differences (p > 0.05) in recurrence when comparing sex, race, ethnicity, insurance, or social vulnerability index. A higher percentage of patients undergoing revision surgery were current or former smokers.

Conclusions: Cholesteatomas are a common and considerably challenging disease process in terms of hearing outcomes, recurrence and subsequent revision surgeries. Once thought to be a disease of those with lower socioeconomic status, investigators found similar rates of recurrence across a variety of sociodemographic variables. Findings underscore the need for future research to assess predictors of cholesteatoma recurrence.