A retrospective review of 110 consecutive cases of COM surgery was performed in a large metropolitan teaching public hospital in the U.S. serving the inner city population with the purpose of identifying Dural dehiscences and encephaloceles (DDE) as well as complications associated with these entities. 29 such patients (26.4%) were identified, 7 were encephaloceles (6.4%). In patients with DDE cholesteatoma was found in 83%, a labyrinthine fistula in 48%, preoperative facial paralysis in 13.8% (4 patients), facial nerve involvement by cholesteatoma in 24% and suppurative intracranial complications in 21%. DDE's were repaired through the mastoid, via a mini - craniotomy or a formal middle cranial fossa approach. The incidence of DDE's in this patient population is very high reflecting neglected chronic ear disease, the associated complications require extensive surgery for eradication and the potential for morbidity and mortality is significant.
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