BackTable / ENT / Podcast / Episode #120
Evaluation and Management of Cholesteatoma
with Dr. Gauri Mankekar
In this episode of BackTable ENT, Dr. Shah and Dr. Gauri Mankekar, assistant professor of Otolaryngology at LSU Health Shreveport, discuss cholesteatoma workup and surgical management.
BackTable, LLC (Producer). (2023, July 18). Ep. 120 – Evaluation and Management of Cholesteatoma [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Gauri Mankekar
Dr. Gauri Mankekar is an otolaryngolgist and head and neck surgeon with Ochsner LSU Health in Shreveport, Louisiana.
Dr. Gopi Shah
Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.
First, Drs. Shah and Mankekar review the basics of cholesteatoma: types, etiology, clinical presentation, and physical exam findings. Doctors should suspect cholesteatoma when they encounter a patient experiencing painless, malodorous ear drainage. Dr. Mankekar underscores the importance of tailoring the physical exam to each patient’s history and needs. For example, when evaluating children for potential cholesteatoma, she works to gain the child’s trust before examining the ear, sometimes using an initial visit to focus on rapport and deferring the exam to the second visit.
Next, the surgeons address workup of cholesteatoma, which should include audiometry, CT scan, and culture of ear drainage (if present). All patients with cholesteatoma require long-term surveillance, as recurrence can happen more than five years after initial treatment. Dr. Shah advises that doctors approach the topic of surveillance by emphasizing the importance of creating a safe ear. Dr. Mankekar then shares tips on how to help patients understand the chronicity of their disease.
Then, the surgeons discuss cholesteatoma operative techniques. Dr. Mankekar leads listeners through her approach to cholesteatoma surgery, from review of CT scans to supplies used in the OR. Dr. Shah delineates common challenges in ear surgery, such as “hard to reach areas”, and Dr. Mankekar shares technical strategies she uses in the OR. They then review the role of endoscopic tympanoplasty, ossicular chain reconstruction, and canal wall down mastoidectomy. As with her ear exam, Dr. Mankekar closely tailors each operation to the patient’s particular pathology. Finally, Dr. Mankekar summarizes her strategy for patient-centered, long-term management of cholesteatoma.
Dr. Mankekar’s Profile:
I think we have to individualize the surgical approach based on our clinical findings and imaging studies. The scope is here to stay, so it's really a very useful tool. The instruments are improving, so we can use them around the corners. I think it's there for the long term. Then, in cholesteatoma, long-term surveillance is absolutely essential. Sometimes, we can see a recurrence as late as five to even eight years down the line, even longer, and so, we do need to see these patients in the long term.
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