Long‐term Results of Adult Cholesteatoma Surgery Using Canal‐Wall‐Down Approach with Primary Obliteration: 5‐Year Observational Study

Abstract

Objectives:Present the results of a 5‐year longitudinal study in an adult population undergoing cholesteatoma surgery using a canal‐wall‐down (CWD) approach with obliteration.Methods:Prospective longitudinal study from 1999 to 2013 in a district general hospital. Subjects studied: Adults (≥16 years) with cholesteatoma (256 ears). Interventions: Surgery for cholesteatoma. (1) Residual, recurrence, and recidivist cholesteatoma rates at 5 years postsurgery; (2) postoperative hearing; (3) postoperative waterproofing of the ear; (4) number of subsequent ear surgeries required. Independent variables: Age and sex.Results:The follow‐up rate at 5 years was 81.5% (n = 195). Using Kaplan‐Meier analysis, the residual cholesteatoma rates at 5 years postsurgery was 2.1% at a rate of 6.5 per 1000 years of adult follow‐up (95% confidence interval [CI]: 2.4‐17.3), representing 4 cases of residual cholesteatoma and no recurrences. The otorrhea rate was 5.6% at 12 months and the rate of definitive waterproofing was 89.8% at 12 months. There was a reoperation rate of only 6.7% at 5 years which included second stage ossiculoplasty. Regarding hearing, 62.2% preserved their hearing (change between −10 to = 10 dB), 36.5% had hearing gain (>10 dB), and 16.9% had hearing reduction at 12 months postoperation. Forty‐eight percent (48%) achieved a postoperative air‐bone gap of ≤20 dB.Conclusions:Use of a CWD approach with obliteration of the mastoid cavity to surgically treat cholesteatoma results in a low recurrence rate and high rate of a trouble‐free ear in the long term.