Prevention of recurrence of cholesteatoma in intact canal wall tympanoplasty.

In the treatment of cholesteatoma employing intact canal wall tympanoplasty, staging the operation and re-establishment of aeration of the tympanic cavity are required to eradicate possible causes of recurrence, cholesteatoma residue, and retraction pocket. The planned staged tympanoplasty with preventive measures for recurrence has evolved. At the second-stage operation, one of the following three types of operations was performed according to the grade of aeration and healing of tympanic cavity: type S1, only ossiculoplasty; type S2, ossiculoplasty and scutumplasty; and type S3, ossiculoplasty, scutumplasty, and mastoid obliteration. The surgical concept, indication, and technique are described in detail. The recurrence rate in the 134 patients without previous surgery, 95 adults and 39 children, operated on between 1987 and 1991 was 2.2 percent (7.6% in the children and 0% in the adult). Although the rate of the recidivism was significantly reduced, deep retraction pocket developed in 15 percent of adults and in 23 percent of children. The incidence of deep retraction pocket formation was lowest in the adults with type S1 operation and highest in the children with type S3 operation.