Longterm results in cholesteatoma surgery

From the results of 689 cases of cholesteatoma operated and followed over a period of 9 years, are discussed the respective indications of opened and closed techniques. The intact canal wall tympanoplasty with mastoidectomy is the preferred technique. It is undertaken on the understanding that it will be done in 2 stages over a 1-year interval. From the revised 460 cases, the presence of residual cholesteatoma was found in one out of 2 cases. Cause of high incidence are analyzed and commented. Retraction pockets or true recurrence of cholesteatoma whose incidence was 11% at the beginning of the series have practically disappeared since it was started to repair the tympanic frame with cartilage. Open techniques, modified radical mastoidectomy, with or without obliteration, are done when a 2-stage procedure is not possible. They are also indicated in particular cases related to the nature of the disease, mastoid pneumatization, condition of the attic wall or the patient's age. Auditory results do not show any significant difference between the open and closed techniques when the ossicular chain is complete or the stapes intact. However, in cases of subtotal ossicular defects, preservation of the tympanic frame provided the most favourable conditions for a functional restoration.