EXTENSIVE CHOLESTEATOMA - LONG-TERM RESULTS OF 3 SURGICAL TECHNIQUES

During the years 1979-81, three different surgical techniques were use d in the treatment of 87 ears with extensive cholesteatoma. All proced ures were performed in one stage by the same surgeon. Ten to 13 years after the operations about 70 per cent of ears operated on by the cana l wall up technique had developed a new cholesteatoma, which in most c ases was recurrent, or a deep retraction pocket. A modification of thi s technique with mastoid obliteration resulted in a similar failure ra te. In contrast, ears operated on by the canal wall down technique (in most cases with mastoid obliteration) had acceptable stability with a long-term recurrence rate of about 15 per cent. Most patients in the canal wall down group had a dry ear without significant cavity problem s. Hearing in these patients was as least as good as hearing in patien ts with a preserved canal wall. We conclude that a meticulous one-stag e canal wall down technique in ears with extensive cholesteatoma resul ts in a high percentage of unproblematic, stable ears with satisfactor y function. In contrast, if the posterior canal wall is preserved, rec urrent cholesteatoma is the rule more than the exception.