Cholesteatoma surgery: the influence of the canal wall.

Although there is an increasing awareness of the risks of complications following intact canal wall tympanoplasty (ICWT) for cholesteatoma, long-term evidence to support a preference for alternative techniques in which the canal wall having been removed, the resultant cavity is obliterated, is comparatively scarce. In order to clarify this uncertainty, long-term results with both operations have been analyzed to determine incidence rates for postoperative complications and functional results. Recurrent cholesteatoma (retraction pocket) has occurred in 14% of ICWT ears and 1% of ears with mastoid obliteration and tympanic reconstruction. The incidence of clinically detected residual disease with both operations has been extremely low so far, in spite of greater than 20% incidence of epithelial pearls at the second stage of separate planned two-stage procedures with each technique. It is concluded that reduction to the greatest degree possible of cholesteatomatous complications from tympanoplasty necessitates removal of the canal wall.