Experience with surgical management of cholesteatomas.

OBJECTIVE To evaluate long-term results after at least 10 years of follow-up for a common method of ear surgery for managing cholesteatomas. METHODS This retrospective study was performed by assessing the medical records of adult patients who underwent canal-wall-down mastoidectomy for management of cholesteatomas. RESULTS From January 1, 1989, through December 31, 1995, 148 patients underwent surgery for cholesteatoma. Of these, 72 (48%) were treated by using the canal-wall-down method. During follow-up (10-16 years), 5 (7%) patients underwent at least 1 revision operation. Ten years after primary surgery, 69 (96%) of the ears were dry and 55 (76%) had intact tympanic membranes with fair hearing in 30 (42%). One patient who was deaf was seen in this group of 72 patients. The recurrence rate was 7%, independent of the size of the cholesteatoma, mastoid status, or labyrinth or footplate erosion. The major predisposing factor for recurrence was retraction, especially in the posterior superior quadrant. CONCLUSION Our results showed that the surgical technique could be improved by using endoscopes to lower the recurrence rate and improve hearing results.