(873) Predictors of Canal Cholesteatoma: A Nationwide Case-Control Study

Introduction: To characterize the demographics of patients with external auditory canal cholesteatoma (EACC) in the US and understand the association with bisphosphonate use, smoking, diabetes, CKD, atherosclerosis/peripheral vascular disease, osteoporosis/osteopenia, cerumen impaction, psoriasis & dermatitis, BMI elevation and history of any oncologic history as well as skin-related malignant neoplasms specifically.

Methods: Herein we performed a propensity-score matched (PSM) retrospective cohort study using the TriNetX database from 70 US HCOs. Cases were adults with EACC (ICD-10: H60.4). Controls were adults with a normal ear/hearing exam (ICD-10: Z01.10) and audiologic function testing (CPT: 1012897), excluding any form of cholesteatoma (ICD-10: H71, 60.4). We compared demographics (age, sex, ethnicity) and associations with bisphosphonates, smoking, diabetes, CKD, atherosclerosis/PVD, osteoporosis/osteopenia, cerumen impaction, psoriasis/dermatitis, BMI elevation, and oncologic/skin malignancy history between EACC patients and PSM controls.

Results: We identified 13,429 EACC cases (mean age 63 ± 21); 52.6% were female (n=7,065) and 71.5% White (n=9,608). After PSM for age, sex, and ethnicity, EACC was associated with smoking (OR 4.86; 95% CI 4.01–5.88), cerumen impaction (4.76; 4.43–5.11), any malignant neoplasm (4.54; 3.26–6.33), CKD (3.22; 2.47–4.19), skin malignancy/melanoma (3.07; 2.18–4.32), atherosclerosis/PVD (2.71; 1.74–4.22), diabetes (2.60; 2.19–3.08), osteoporosis/osteopenia (1.99; 1.49–2.68), and psoriasis/dermatitis (1.73; 1.22–2.45). BMI >25 showed a small association (1.17; 1.11–1.24), while bisphosphonate use was not significant (1.67; 0.971–2.87).

Conclusions: Patients with EACC demonstrated significant associations with smoking, cerumen impaction, history of any malignant neoplasm, CKD, history of skin-related malignant neoplasm/melanoma, diabetes, atherosclerosis/peripheral vascular disease, osteoporosis/osteopenia, psoriasis or dermatitis. These findings have implications for the understanding of the etiopathogenesis of EACC.