To compare cholesteatoma recidivism
rates after exclusive transcanal technique
(ETC), combined transcanal and mastoidal technique (TCM, both subsets of intact canal wall technique, ICW), and canal wall down
Retrospective case review and clinical case study
Tertiary referral center.
surgeries (2007–2009), 116 ears in clinical re-examination at least 1 year postoperatively.
surgery with ETC, TCM, or CWD.
Main Outcome Measures Cholesteatoma recidivism
, residual and recurrent disease
, localization of recidivism
, validity of clinical findings.
Out of 406 patients, ETC was performed in 227 (56%), TCM in 122 (30%), and CWD in 57 (14%) cases. Recidivism
rates after ICW (15%) and CWD (16%) were almost similar. Recidivism
was more frequent after ETC (11%) than after TCM (25%). Residuals were observed in 2% after ETC, 6.5% after TCM, and 7% after CWD. Incidence of recurrent disease
was 9% for ETC, 18% for TCM, and 9% for CWD. Preferred localization of recidivism
was the tympanic cavity after ETC (92%) and CWD (56%) and the mastoid cavity after TCM (53%). The clinical re-examination showed no further recidivistic disease.
Sequential surgery is an effective and successful strategy in cholesteatoma
eradication, providing a similar recidivism
rate compared to following cholesteatoma
retrograde and resection of the posterior canal wall. Lower recidivism
after ETC was observed as a consequence of limited disease and the postoperative middle ear status determined the higher rate of recurrence after TCM. Therefore, the restricted visualization of the middle ear during ICW surgery does not increase the rate of recidivism
, compared with CWD, as described in other studies. Cholesteatoma recidivism
is mainly attributed to the surgeon’s experience that outweighs the chosen strategy.