Surgery in cholesteatoma: Ten years follow-up

During last decades, many otologists attempted to make a long standing dry ear, resulting in better hearing after cholesteatoma surgery. This study evaluated the prognosis of two common methods of cholesteatoma ear surgery considering ten years follow-up. This retrospective analysis was done using medical records of 108 adult patients with cholesteatoma. After ten years of operation, in these patients we compared the results of the two major trends of canal wall up (CWU) and canal wall down (CWD). Among these patients, 72 (67%) and 36 (33%) underwent the CWD and CWU method respectively. During follow-up, 8% of patients with CWD and 21% of those with CWU had undergone at least one revision operations. Ten yrs after primary surgery, 93% of the ears were dry, 90% with intact tympanic membrane, with 42% of CWD and 52% of CWU groups having fair hearing. One deaf individual was found in each group. The recurrence rate was reported in 6% of CWD and 17% CWU patients, and independent of the size of cholesteatoma, mastoid status or foot plate erosion. The major predisposing factors for recurrence were retraction and discharge, especially in combination. Intact tympanic membrane was more frequent in CWD group, although there was no significant difference between the recurrence rates of these two groups. The result of this study indicated a need for improving surgical techniques in order to lower the recurrence rate and improvement of hearing, especially with the help of endoscopes.