Staged intact canal wall tympanoplasty for treatment of middle ear cholesteatoma.

Results of surgery for middle ear cholesteatoma were investigated in 202 ears of 197 patients who had undergone surgery by the staged intact canal wall technique. Surgical procedures used in the second stage for prevention of a retraction pocket were classified into three types: Type S1, no scutumplasty; Type S2, scutumplasty; Type S3, scutumplasty plus mastoid obliteration. Recurrent cholesteatoma was found in 9 ears (4%) and retraction pocket in 47 ears (23%). They occurred between 2 and 120 months (average: 26 months) after the second stage, most frequently at 1 to 3 years. The incidence was higher after Type S3 surgery than after the other types, probably because the middle ear was severely involved in patients who were indicated Type S3 surgery. For prevention of a retraction pocket, bone putty and cartilage were proved to be appropriate materials for scutumplasty, and hydroxyapatite for mastoid obliteration. As the retraction pocket tended to recur in patients with the pocket at the second stage, these patients needed obliteration of the mastoid cavity to prevent a retraction pocket. Postoperative hearing was evaluated according to the criteria proposed by the Japan Society of Clinical Otology. Of 145 ears of the 142 patients who were followed for more than 1 year, 118 ears (81%) the surgery was judged successful. The success rate in hearing was in good accordance with the condition of the tympanic membrane.