FUNCTIONAL LONG-TERM RESULTS AFTER OPEN C HOLESTEATOMA SURGERY AND OSSICULOPLASTY WITH HOMOLOGOUS OSSICLES IN ADULTS

Background: Characteristic features of cholesteatoma of the middle ear are destruction of the bone and a high tendency for recurrent disease . The choice of surgical procedure is determined by audiological resul ts and the rate of recurrent cholesteatoma. Patients: One hundred fift y patients who underwent primary cholesteatoma surgery were investigat ed 3-5 years postoperatively. Preoperative and postoperative audiologi cal results and rate of revision surgery were compared for the respect ive surgical procedures. All cholesteatomas were treated with an open surgical technique. The lateral attic walls and cholesteatomas were re moved. Results: Cholesteotoma recurred in 15 patients (10%). Primary r econstruction of the ossicular chain with a tympanoplasty (type III) w as performed in 98 patients in the first operation. Approximately 80% of patients treated with a type III tympanoplasty had a maximum postop erative air-bone gap of 20 dB in the main speech range, depending on t he frequency. In about 50% of patients, this value was 10 dB or less. Comparison of preoperative and postoperative conductive hearing loss b etween 250 Hz and 8000 Hz revealed an improvement (p < 0,05) of 10 dB (500 Hz, 3000 Hz, 4000 Hz) and 15 dB (250 Hz, 1500 Hz, 2000 Hz, 8000 H z). Conclusions: In our opinion, a second look operation should be per formed in cases where a large cholesteatoma cannot be removed with suf ficient reliability. This applies especially to a cholesteatoma in the oval window. Here, we suggest second-look surgery after one year.