Risk Factors for Recidivism in Stage II Pars Flaccida Cholesteatoma: Impact of Disease Extent and Surgical Procedures

Objective: According to the joint consensus of the European Academy of Otology and Neurotology and the Japan Otological Society on middle ear cholesteatoma, stage II encompasses a broad range of disease extensions, leading to variability in treatment outcomes among individuals with this disease stage. Herein, we aimed to investigate the risk factors for recidivism in stage II pars flaccida (PF) cholesteatoma. Study design: Retrospective cohort study. Setting: University hospital. Patients: In total, 228 consecutive ears with stage II PF cholesteatoma were treated surgically and followed up for >12 months. Interventions: Patients underwent transcanal atticotomy, canal wall up tympanoplasty, or canal wall down (CWD) tympanoplasty with or without mastoid obliteration (MO). Main outcome measures: Recidivism rates, assessed using the Kaplan-Meier method, correlated with potential risk factors, including age, number of sites involved, difficult access sites (S1: supratubal recess, S2: tympanic sinus), and surgical procedures. Results: The recidivism rate was significantly higher in pediatric patients (42.8%) than in adults (6.1%). Furthermore, recidivism rates were greater in patients with 3 or more involved sites (16.5%), S1 involvement (27.9%), and procedures other than CWD+MO (24.5%) than those with 2 involved sites (3.0%), no S1 involvement (5.1%), and underwent CWD+MO (5.4%), respectively. Multivariate analysis identified the involvement of 3 or more sites (hazard ratio: 5.12) and procedures other than CWD+MO (hazard ratio: 6.49) as independent risk factors for recidivism. Conclusion: In stage II PF cholesteatoma, involvement of 3 or more sites was identified as a risk factor for recidivism. CWD+MO intervention may reduce the recidivism rate.