Type III tympanoplasty with cartilage obliteration for cholesteatoma surgery

The main objective of cholesteatoma surgery is complete eradication of the disease. Another goal is to preserve hearing acuity. We reviewed type III tympanoplasty with cartilage obliteration for cholesteatomatous ears. To evaluate the role of ossiculoplasty, the functional results of classic and modified type III tympanoplasties were compared.

Thirty-six cholesteatomatous ears undergoing type III tympanoplasty with cartilage obliteration were reviewed. The same operator performed these operations from 1984 until 1995. According to the CAO staging system, there were five early, 16 moderate and 15 advanced-stage cases of cholesteatoma. Using the anterior approach, all operations were canal-wall-down type III tympanoplasties with "tailored" open cavity and cartilage obliteration. There were 24 classic and 12 modified type III tympanoplasties.

The average follow-up duration was 7.2 years. Neither recidivistic cholesteatoma nor retraction pocket was observed postoperatively. There was an improvement in atelectatic score after surgery. The mean postoperative air-bone gap (ABG) was 15.8 +/- 10.7 dB and the mean closure of the ABG was 4.0 +/- 14.3 dB. After the disease stage and preoperative hearing status were adjusted using regression analysis, there was no significant difference in hearing results between ears that underwent classic or modified type III tympanoplasties.

We performed the canal-wall-down tympanoplasty with cartilage obliteration using the anterior approach for treatment of cholesteatoma. Such surgical techniques eradicate the cholesteatoma, prevent its recurrence and create a clean ear. Hearing reconstruction can also be accomplished in a single-stage procedure offering a serviceable hearing acuity.