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        Advanced stage of cholesteatoma presenting to medical services in Cambodia
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        Advanced stage of cholesteatoma presenting to medical services in Cambodia
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        Advanced stage of cholesteatoma presenting to medical services in Cambodia
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Learning Objectives: To understand that, in Cambodia, cholesteatoma is often at an advanced stage at presentation. Extrapolation from geographic data suggests that there are barriers to access in remote locations.

Introduction: We have recently instigated the first continual program for tympanomastoid surgery in Cambodia at the Children's Surgical Centre, Phnom Penh. We provide care for adults and children, and cover a population of 15 million individuals, who have previously had no access to otological surgery. We set out to ascertain the severity of disease presenting to us, and proxy measures of access to care, through a retrospective review of patient records.

Methods: We reviewed operative records of all patients undergoing tympanomastoid surgery between February 2014 and March 2016. We recorded the extent of disease, the presence of ossicular erosion, and the location and extent of erosion of the temporal bone. We compared our findings to those reported in the literature. We also used the home address of those presenting to our services to calculate the distance travelled to our centre, and compared this to the population density of each region.

Results: We retrieved records of 74 cases. Erosion of the facial canal, lateral semicircular canal, tegmen, and the ossicles is more extensive and common than reported in previous epidemiological studies. Very extensive disease is also recorded, including post-aural fistulae or abscesses, erosion into the parotid gland, exposure of the sigmoid sinus, and erosion into the internal auditory meatus. Many people had suffered for years before seeking medical care. People living near to our centre were over-represented in our cohort.

Conclusions: Cholesteatoma in Cambodia is at an advanced stage compared to that presenting in the developed world. The epidemiology of those presenting to our centre suggests that awareness of, and access to care is a significant issue for those in remote locations. This is one of the first studies to report on cholesteatoma epidemiology in the developing world, and the findings give impetus to efforts to develop infrastructure to support ear care across the developing world.