Cholesteatoma recidivism: comparison of three different surgical techniques.

OBJECTIVE

To compare cholesteatoma recidivism rates after exclusive transcanal technique (ETC), combined transcanal and mastoidal technique (TCM, both subsets of intact canal wall technique, ICW), and canal wall down surgery (CWD).

STUDY DESIGN

Retrospective case review and clinical case study

SETTING

Tertiary referral center.

PATIENTS

406 cholesteatoma surgeries (2007-2009), 116 ears in clinical re-examination at least 1 year postoperatively.

INTERVENTION

Sequential cholesteatoma surgery with ETC, TCM, or CWD.

MAIN OUTCOME MEASURES

Cholesteatoma recidivism, residual and recurrent disease, localization of recidivism, validity of clinical findings.

RESULTS

Out of 406 patients, ETC was performed in 227 (56%), TCM in 122 (30%), and CWD in 57 (14%) cases. Recidivism rates after ICW (15%) and CWD (16%) were almost similar. Recidivism was more frequent after ETC (11%) than after TCM (25%). Residuals were observed in 2% after ETC, 6.5% after TCM, and 7% after CWD. Incidence of recurrent disease was 9% for ETC, 18% for TCM, and 9% for CWD. Preferred localization of recidivism was the tympanic cavity after ETC (92%) and CWD (56%) and the mastoid cavity after TCM (53%). The clinical re-examination showed no further recidivistic disease.

CONCLUSIONS

Sequential surgery is an effective and successful strategy in cholesteatoma eradication, providing a similar recidivism rate compared to following cholesteatoma retrograde and resection of the posterior canal wall. Lower recidivism after ETC was observed as a consequence of limited disease and the postoperative middle ear status determined the higher rate of recurrence after TCM. Therefore, the restricted visualization of the middle ear during ICW surgery does not increase the rate of recidivism, compared with CWD, as described in other studies. Cholesteatoma recidivism is mainly attributed to the surgeon's experience that outweighs the chosen strategy.