Anatomic findings one year after combined approach tympanoplasty

Fifty-six patients were treated surgically for middle ear cholesteatoma using the combined approach tympanoplasty technique. One year later a second-look procedure was performed in all the patients, which permitted the anatomic effects of the combined technique to be mapped out before ossicular reconstruction was performed. At three, six, and twelve months after the first operation the development of retraction pockets was also studied. Recurrent cholesteatoma was found in twelve cases (21.4%), and residual cholesteatoma in fourteen (25%). The posterior tympanotomy was closed in 31 cases (55.4%), whereas the mastoidectomy cavity was overgrown and closed in 22 (39.4%). Twelve months after the first operation (just before the second look), a retraction pocket was found in twenty-one cases (37.5%), and at the second-look operation twelve of these were proven to be a manifest recurrent cholesteatoma. The formation of new retraction pockets was found to be time-dependent, that is, to increase almost linearly during the control interval between the operations. The investigation shows the necessity for standardizing the presentation of results after cholesteatoma operations and the importance of determining a convenient postoperative time for reporting the incidence of cholesteatoma recurrences.