Abstract
The two major purposes of tympanoplasty are the removal of pathological middle ear tissues and ossicular chain reconstruction (ossiculoplasty) to improve hearing. We summed up the cases of primary acquired pars flaccida cholesteatoma experienced in this hospital, namely the extent of choleastoma observed during tympanoplasty, post-surgical hearing outcomes and recurrence rate. 120 cases of primary acquired pars flaccida cholesteatoma underwent tympanoplasty in Kurashiki Central Hospital from October 2004 to June 2011. Our basic procedure was to perform tympanoplasty with postauricular incision, canal wall up technique (CWU), and primary ossiculoplasty. Ossiculoplasty type III with columella (IIIc) was performed in 73.3% of all cases. The patients were followed-up for a median period of 61 months (range, 13 to 95 months). Subjects were classified according to the extent of cholesteatoma based on the staging criteria for middle ear cholesteatoma 2010 Japan. The total success rate of postoperative hearing outcomes was 91.1%. The postoperative hearing outcomes were influenced significantly by the extent of stapedial abnormality. The recurrence rate of cholesteatoma was 18.3%. Recently, sufficient scutumplasty tended to decrease the retraction pocket formation after tympanoplasty. In general, the canal wall up technique resulted in higher rates of residual cholesteatoma and retraction pocket compared with the canal wall down technique. Postoperatively, regular follow-up for at least 10 years is essential to identify the formation of cholesteatoma recurrence.
