[Surgical strategy for treatment of cholesteatoma otitis media]

To study the otologic surgical procedures for cholesteatoma otitis media and improve the surgery results and living quality of patients following the operation of tympanomastoidectomy.

Two hundreds and sixty-six cases (269 ears) of tympanomastoidectomy for cholesteatoma otitis media followed up for more than 3 years between 1994 to 2003 were analyzed retrospectively. The long-term results of recurrence and hearing level was discussed on the procedure of canal wall up (CWU), canal wall down (CWD) and modified intact-bridge tympanomastoidectomy (IBM).

On the contrast of improved hearing level, there were not significant difference between CWU group and CWD group (F = 3.686, P>0.05), but the results of IBM group was significantly better than others (F = 125.167 and 59.438, P <0.05). On the contrast of duration of getting dry ear, IBM and CWU groups [(5.0 +/- 1.9) weeks and (6.0 +/- 1.6) weeks respectively] were significantly shorter than CWD group [(9.0 +/- 2.8) weeks; F = 56.32 and 30.639, P <0.05]. As the recurrence rate, IBM group and CWD group were significantly lower than CWU group (CWU: 24.6%; CWD: 6.0%; IBM: 7.0%) chi2 = 6.162 and 6.007, P < 0.05).

With the modified IBM technique, cholesteatoma could be removed completely and safely from the middle ear and a reasonable reconstruction of middle ear with approved hearing level could be achieved. The surgical procedure usually began with CWU and should be change according to the pathological founding of middle ear during operation. Modified IBM was a valuable choice for the surgical treatment of cholesteatoma otitis media.