Monash University and Monash Health collaborative study improves management of ear surgery

Research team photo with prize medal (L-R):
Mr Paul Paddle, Dr. Stacy Goergen,
Mr Guillermo Hurtado

A collaborative research study at Monash has received the prestigious Royal Australasian College of Surgeons RC Bennett Award for the best clinical research paper at the 2015 Victorian-Tasmanian Annual Surgical Meeting.

Led by Monash Health Ear Nose and Throat (ENT) surgeon Mr Paul Paddle, the study investigated the diagnostic accuracy of an imaging technique, Non Echo-planar diffusion weighted (non-EPI DWI) MRI in detecting recurrent cholesteatoma—an abnormal skin growth in the middle ear behind the eardrum.

With collaborators including Director of Research, Department of Imaging Professor Stacy Goergen, Monash Health ENT surgeon Mr Guillermo Hurtado and Alfred Health ENT surgeon Professor Vince Cousins, the blinded study also analysed the role of non-EPI DWI MRI in surgical decision-making in cholesteatoma.

Temporal Bones CT scan shows
 left middle ear
non-specific opacification

“In an Australian-first, this study validates the use of this specific MRI technique as an additional tool for the management of cholesteatoma,” said Mr Hurtado.

Cholesteatoma is a common, non-malignant but destructive lesion that can cause erosion of bones such as the ossicles, the mastoid process or the skull base. Management of cholesteatoma is challenging and requires complex middle ear surgery.

‘Cholesteatoma can develop in up to 10% of people with chronic suppurative otitis media (CSOM), a chronic inflammation of the middle ear and mastoid cavity,” said Mr Hurtado. 

“CSOM is a major public health issue, with the World Health Organization estimating between 65–330 million people worldwide being affected, mostly in the developing world.”

“Imaging techniques such as CT scan and MRI assist confirmation of clinical suspicion and postoperative evaluation, however, differentiation of cholesteatoma from other types of middle ear inflammation or postoperative changes is not yet available,” said Mr Hurtado.

Currently, revision surgery and histopathology analysis is the standard of care to exclude recurrence of cholesteatoma disease.

“Conclusions from our study will aid in the development of a formal cholesteatoma post-operative patient management protocol at Monash Health ENT Department,” added Mr Hurtado.

“Further research including additional cost-effectiveness analysis could potentially lead to reducing healthcare costs for the management of our large group of patients affected by cholesteatoma disease.”