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.