CHOLESTEATOMA SURGERY AT THE OTOLOGIC MEDICAL GROUP

Abstract

This article is based on our reports at the International Cholesteatoma Conference, in Tel Aviv, March 1981. Included are a review of the evolution of the intact canal wall technique at the Otologic Medical Group and a detailed review of the findings at planned and unplanned revisions. We are currently using the intact canal wall procedure in 75 percent of our surgical procedures for cholesteatoma and obliteration technique in 20 percent, and leaving the cavity exteriorized in 5 percent. Seventy-five percent of the procedures are staged. Planned revisions were indicated to obtain an ear free of disease and an ear with satisfactory hearing. Residual disease was suspected in half of the revisions but found in only one-fourth. The middle ear was more commonly involved than the epitympanum or mastoid. A satisfactory functional result was obtained in 80 percent. Unplanned revisions were indicated primarily because of an unsatisfactory hearing result. Recurrent cholesteatoma was the indication in only fifteen cases. Residual cholesteatoma was uncommon. The key factor in the understanding of the incidence of residual and recurrent disease, and the functional result, is an understanding of the surgeons' philosophy. Surgeons who vigorously pursue a good functional result in all cases face a dilemma, regardless of how they manage the mastoid. The more persistent they are, the more problems they may encounter. A planned two-stage procedure frequently will be necessary to accomplish the dual objectives of tympanoplasty surgery: an ear free of disease and an ear with a good functional result.