Residual and recurrent cholesteatoma in closed tympanoplasty

There are actually two principal approaches to the surgical treatment of middle ear cholesteatoma, a subject very much debated. First, the cholesteatoma can be exteriorized and treated with an open technique (classic or modified radical mastoidectomy, open tympanoplasty); and second, the radical removal of the cholesteatoma is also possible in the majority of cases by closed tympanoplasty. In this article we examine 283 patients (forty-four children and 239 adults) operated on by the closed technique to review and discuss the postsurgical cholesteatoma problem (residual and recurrent). Total incidence of residual cholesteatoma is 13.43 percent. It is higher in children (25 percent) than in adults (11.72 percent) and is more frequently localized in the mesotympanum (47.54 percent) than in the epitympanum (40.98 percent) or in the mastoid (6.56 percent). Recurrent cholesteatoma, with a total incidence of 7.77 percent, is much less frequent when staged tympanoplasty has been performed than when a one-stage operation has been done. No endotemporal or endocranial complications (labyrinthine fistula, facial nerve paralysis) have been noticed in cases of postsurgical cholesteatoma. These data confirm the opinion that staged tympanoplasty with Silastic sheeting and reconstruction of the erosions of the posterior wall is the technique of choice for surgical therapy of middle ear cholesteatoma.