Results of surgery for middle ear cholesteatoma.

Operative findings and results in cases of middle ear cholesteatoma were analyzed with special reference to postoperative hearing and recurrence of cholesteatoma. Of the 242 ears operated on in the past 9 years and 9 months, intact canal wall tympanoplasty was performed in 114 ears, tympanoplasty with the posterior canal wall removal in 81 ears, and radical mastoidectomy in 47 ears. Of the 139 ears observed for more than 6 months after tympanoplasty, postoperative hearing was improved in 34 ears (24.5%), decreased in 15 ears (9.3%)and still in the range of the preoperative level in 90 ears (66.2%). Recurrence of the cholesteatoma was found in 15 ears (6.2%), five of which had been treated by radical mastoidectomy. Though therewere no such recurrences in 46 patients treated by staged intact canal wall tympanoplasty, a retraction pocket which was considered to be a precursor of cholesteatoma was found in seven cases (15.2%). In order to avoid a etraction pocket in intact canal wall tympanoplasty, closure of the attic accompanied by obliteration of the mastoid cavity is advised.