Proposal of a timing strategy for cholesteatoma surgery during the COVID-19 pandemic

Mercy George, Arun Alexander*, John Mathew, Arunachalam Iyer, Jerome Waterval, Christian Simon, Daniele Marchioni, Raphael Maire

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Purpose The COVID-19 infection is an aggressive viral illness with high risk of transmission during otolaryngology examination and surgery. Cholesteatoma is known for its potential to cause complications and scheduling of surgery during the pandemic must be done carefully. The majority of otological surgeries may be classified as elective and postponed at this time (e.g., stapedotomy, tympanoplasty); whereas, others are emergencies (e.g., complicated acute otitis media, complicated cholesteatoma with cerebral or Bezold's abscess, meningitis, sinus thrombosis) and require immediate intervention. What is the ideal time for the surgical management of Cholesteatoma during the COVID-19 pandemic? Methods Senior otologic surgeons from six teaching hospitals from various countries affected by the COVID-19 from around the world met remotely to make recommendations on reorganizing schedules for the treatment of cholesteatoma which has a risk of severe morbidity and mortality. The recommendations are based on their experiences and on available literature. Results Due to the high risk of infecting the surgical staff it is prudent to stop all elective ear surgeries and plan cholesteatoma surgery after careful selection of patients, based on the extent of the disease and available resources. Specific precautions including use of appropriate personal protection equipment should be followed when operating on all patients during the pandemic. To facilitate the decision-making in the management of cholesteatoma, timing for surgery can be divided into two categories with 3 and 2 sub-groups based on disease severity. Conclusions Evidence on the timing of surgery of patients with cholesteatoma during the COVID-19 pandemic is lacking. This manuscript contains practical tips on how cholesteatoma surgery can be reorganized during this pandemic.

Original languageEnglish
Pages (from-to)2619-2623
Number of pages5
JournalEuropean Archives of Oto-Rhino-Laryngology
Issue number9
Publication statusPublished - Sept 2020


  • COVID-19
  • Coronavirus
  • Cholesteatoma
  • Safety precautions


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