Modification of combined-approach tympanoplasty in attic cholesteatoma

Late results of operations on 224 attic cholesteatomas were analyzed three to 16 years after operation. In 133 ears a modification of combined-approach tympanoplasty was applied and in 91 ears a conservative radical operation with obliteration was performed. All ears were operated on in one stage and 11% were reoperated on during the observation period. No significant differences between the two methods were found, neither with regard to recurrent cholesteatoma--found in 6% with canal-up technique and in 2% with canal-down technique--nor regarding hearing results. With canal-up technique, retractions developed in 38% of ears that progressed and often ended up being small, peaceful, open cavities. It is concluded that treatment of cholesteatoma should be individualized, that no single method is preferable in all cases, and that an intact ossicular chain should be preserved.