Ossiculoplasty in Cholesteatoma: An Evaluation of Necessity Versus Discretion in a Tertiary Center Retrospective...

While the main aim of cholesteatoma surgery is to eradicate the disease and minimize the risk of recurrence, achieving the best possible hearing after surgery remains a key secondary objective, one that matters greatly to patients. Predicting an individual's postoperative hearing outcome is difficult because it depends not only on factors such as the condition of the ossicular chain, the type of ossicular reconstruction, and the extent of the cholesteatoma, but also potentially on other influences, including middle-ear aeration, which has been suggested to affect hearing results.

This study aimed to assess hearing outcomes, measured as air-bone gap (ABG) gain, in canal wall down mastoidectomy (CWDM) patients who underwent ossiculoplasty with TORP or PORP, either concurrently or at six months postoperatively, with or without mastoid obliteration.

This retrospective cohort study reviewed all adult patients who underwent CWDM at a tertiary referral hospital between 2017 and 2024 and completed audiological follow-up at our institution. Hearing outcomes were evaluated using standardized audiometry at three time points: preoperative baseline, an early postoperative assessment, and a longer term postoperative follow-up. Changes in hearing measures over time were quantified, and we examined potential predictors of postoperative hearing performance, including patient- and surgery-related factors that might influence auditory recovery.

Among 45 patients (62.2% men; mean age: 33.98 ± 10.8 years), baseline hearing averaged 47.5 ± 7.7 dB air conduction (AC), 19.9 ± 7.1 dB bone conduction (BC), and 27.5 ± 10.2 dB ABG. Age and pretreatment measures were nearly symmetric, whereas posttreatment AC/BC showed positive skewness (BC strongest). Groups I-IV did not differ significantly on any audiologic variable (all p values >0.05). Repeated analysis of covariance showed significant time effects for AC (p = 0.003; η_p² = 0.195) and ABG (p < 0.001; η_p² = 0.26), but not for BC; Wilcoxon tests still indicated a change for BC (p = 0.005). Assumptions were largely satisfied overall (Levene/Box).

CWDM with ossiculoplasty produced significant improvement in AC and ABG over time, with no differences by reconstruction type, timing, or mastoid obliteration. BC changes were limited, reflecting heterogeneous outcomes and warranting larger studies.