Experience With Surgical Management of Cholesteatomas

OBJECTIVE: To evaluate long-term results after at least 10 years of follow-up for a common method of ear surgery for managing cholesteatomas. METHODS: This retrospective study was performed by assessing the medical records of adult patients who underwent canal-wall-down mastoidectomy for management of cholesteatomas. RESULTS: From January 1, 1989, through December 31, 1995, 148 patients underwent surgery for cholesteatoma. Of these, 72 (48%) were treated by using the canal-wall-down method. During follow-up (10-16 years), 5 (7%) patients underwent at least 1 revision operation. Ten years after primary surgery, 69 (96%) of the ears were dry and 55 (76%) had intact tympanic membranes with fair hearing in 30 (42%). One patient who was deaf was seen in this group of 72 patients. The recurrence rate was 7%, independent of the size of the cholesteatoma, mastoid status, or labyrinth or footplate erosion. The major predisposing factor for recurrence was retraction, especially in the posterior superior quadrant. CONCLUSION: Our results showed that the surgical technique could be improved by using endoscopes to lower the recurrence rate and improve hearing results.