RESIDUE OF MIDDLE-EAR CHOLESTEATOMA AFTER INTACT CANAL WALL TYMPANOPLASTY - SURGICAL FINDINGS AT ONE-YEAR

The rate of residual disease after surgery for acquired middle ear cho lesteatoma was investigated in 167 ears of 164 patients who had underg one planned second-look tympanoplasty by the intact canal wall techniq ue. Overall, operative findings at the second stage revealed 65 cases of residual disease in 48 ears (29%). These consisted of 50 squamous p earls, 11 cases of the flat, open type, and 4 cases of the extensive t ype. The configuration of residual disease is closely related to the t echnical difficulty of eradication, since en bloc removal is much easi er in the squamous pearl than in the open or extensive type, mainly be cause of the unclear margin with the surrounding tissues. The proporti on of cases of the open type was greater in children than in adults, i n pars tensa cholesteatoma than in pars flaccida cholesteatoma, and in severe primary middle ear disease than in moderate or mild disease, a lthough these differences were not statistically significant, The exte nsive type occurred in 4 ears with severe primary disease, 3 of which were in children. These results support the value and importance of th e staged procedure for middle ear cholesteatoma, particularly when ope rated on by the intact canal wall technique.