This study was conducted to determine the appropriate surgical options to improve the hearing outcomes in patients with cholesteatoma who underwent type 3 ossiculoplasty. A total 102 cases of fresh cholesteatoma treated between April 2012 and April 2019 were included. Of the 102 patients, 61 underwent single-stage ossiculoplasty and 41 underwent second-stage ossiculoplasty. The associations of the following variables with the hearing outcomes were analyzed: age, gender, type of cholesteatoma, stage, tympanic cavity invasion, statuses of the stapes and mastoid cell development, stage of surgery, surgical method, type of ossiculoplasty, and type of columella. The hearing outcomes were evaluated on the basis of the mean postoperative air-bone gap. The analysis identified the following prognostic factors for good hearing outcomes: age under 65 years, well-pneumatized mastoid, S0 (no stapes involvement), and surgery without destruction of the canal wall. Second-stage ossiculoplasty was advantageous in terms of the hearing outcomes as compared to single-stage ossiculoplasty for patients with poorly developed mastoid cell structures (MC0 and MC1).
