PREVENTION OF RECURRENCE OF CHOLESTEATOMA IN INTACT CANAL WALL TYMPANOPLASTY

In the treatment of cholesteatoma employing intact canal wall tympanop lasty, staging the operation and re-establishment of aeration of the t ympanic cavity are required to eradicate possible causes of recurrence , cholesteatoma residue, and retraction pocket. The planned staged tym panoplasty with preventive measures for recurrence has evolved. At the second-stage operation, one of the following three types of operation s was performed according to the grade of aeration and healing of tymp anic cavity: type S1, only ossiculoplasty; type S2, ossiculoplasty and scutumplasty; and type S3, ossiculoplasty, scutumplasty, and mastoid obliteration. The surgical concept, indication, and technique are desc ribed in detail. The recurrence rate in the 134 patients without previ ous surgery, 95 adults and 39 children, operated on between 1987 and 1 991 was 2.2 percent (7.6% in the children and 0% in the adult). Althou gh the rate of the recidivism was significantly reduced, deep retracti on pocket developed in 15 percent of adults and in 23 percent of child ren. The incidence of deep retraction pocket formation was lowest in t he adults with type S1 operation and highest in the children with type S3 operation.