Which technique is better for cholesteatoma surgery?

The objective of this study was to evaluate the long-term surgical outcomes and recurrence rates of three surgical techniques that are commonly used for cholesteatoma.

The hospital records of 132 patients with primary cholesteatoma who underwent surgery between January 1996 and December 2006 were evaluated retrospectively. Twelve cases had bilateral disease, and a total of 144 ears were treated. The patients were divided into three groups according to surgical technique: modified radical mastoidectomy (MRM) (n = 48 ears), radical mastoidectomy (RM) (n = 42 ears), and intact canal wall mastoidectomy (ICWM) (n = 54 ears). MRM and RM procedures are canal wall down (CWD) techniques, whereas the ICWM procedure is a canal wall up (CWU) technique. Postoperatively, all patients were followed up yearly for at least 6 years. The otomicroscopic features, cholesteatoma extension, surgical findings, and recurrence rates were compared in the groups.

Preoperative otomicroscopic examination showed attic retraction or perforation in 32% of the cases and central perforation in 11%. There was a higher cholesteatoma recurrence rate in the ICWM group than in the MRM and RM groups (p < 0.05), but there was also better hearing gain in the ICWM group (p < 0.05).

There are several surgical techniques for eradicating cholesteatoma. Our study found that CWD procedures (RM, MRM) were more effective for the eradication of cholesteatoma, but hearing gain was better when a CWU technique was used. The choice of surgical technique should be individually tailored based on the pre-operative imaging and hearing examination findings.